The fact that bad food can cause an upset stomach is not exactly a news flash. But the way in which diet affects a chronic digestive problem is a bit more of a mystery. Scientists are still at work unraveling many of the connections. However, it’s quite clear that the disorders discussed in this chapter are profoundly influenced by what you do or do not eat, or can be helped by adding or eliminating certain types of food. Changing your diet as a first step in therapy is usually a wise choice and is certainly more cost effective than waiting until the problem puts you in the hospital. In the United States alone, 10 million people each year are hospitalized with digestive disorders, and some $107 billion is spent on direct and indirect medical costs.
Fortunately, drugs and surgery are available for severe conditions. And for some problems, seeing your doctor is the best course from the start. Most gastric ulcers for instance, can now be easily cured with antibiotics; so why condemn yourself to a bland diet instead?
The digestive tract is really just a long, winding tube. Rings of thick muscle, or sphincters, cordon off different sections of the tube: the esophagus, stomach, small intestine, and large intestine. Each section has its own role to play in digestion; and each can fall victim to its own set of ailments.
Stretching some 40 feet in adults, the digestive tract receives nine to 10 quarts of internal secretions daily to aid the digestive process. The salivary glands add a little over a quart of saliva each day to change starchy foods to sugars. Saliva mixes with food to create a ball of slippery material called a bolus. As the bolus makes its way down the esophagus, the sphincter connecting the esophagus to the stomach—the lower esophageal sphincter (LES)—relaxes, allowing the bolus to enter. When the LES relaxes at the wrong time, and gastric juices are “refluxed” back into the esophagus, heartburn occurs.
The stomach is a bulge in the digestive tube about the size of your two fists together. It can expand to twice its size after a large meal. If you eat too much food, or if you swallow some dangerous compound (like poison), vomiting can ensue.
Most food stays in the stomach for three to five hours as the stomach muscles churn and squeeze it. The stomach is lined with glands that secrete about two quarts of gastric juice daily to aid this part of the digestive process. Gastric juice consists primarily of water, pepsin (an enzyme to break down protein), and hydrochloric acid.
Trouble Spots Along the Tract
||With 40 feet of tubing in which things can go wrong, it’s no wonder that the digestive tract is the source of so many woes. Some areas are more trouble-prone than others. The juncture of the esophagus and the stomach—source of all our heartburn—is one. Another is the zone where the lower end of the stomach meets the small intestine, a favored haven for ulcers. Finally, towards the end of the tract, the large intestine is victim to more than its share of irritation and inflammation.
Although dietary changes can relieve some of our digestive problems, a surprising number seem unaffected by the food we eat. For instance, while the (often ineffective) prescription for ulcers used to be a bland diet, we now know that antibiotics are usually an effective remedy.
Some people cannot break down proteins properly. They are intolerant to certain proteins, most often those found in the gluten of wheat, rye, and barley. Other people have low levels of the intestinal enzyme lactase—which is responsible for breaking down lactose (milk sugar)—and are therefore intolerant to milk. Such intolerance can lead to diarrhea, gas, and cramps, but it also can be responsible for more serious conditions, such as malnutrition and iron-deficiency anemia, and can aggravate celiac sprue, another name for gluten intolerance.
Hydrochloric acid kills some of the bacteria you ingest with food and also breaks down the complex sugar sucrose into the simpler glucose that the body uses for fuel. It was once believed that this acid was solely responsible for ulcers, but it’s now agreed that a bacteria plays the primary role in the disease. A deficiency of hydrochloric acid is also suspected of causing common indigestion and gas, and bacterial infections.
Among the elderly, this lack of stomach acid can even contribute to deficiencies of iron, calcium, and vitamin B12. And the excessive growth of bacteria that often accompanies the problem can interfere with the function of bile acids, which are needed for normal digestion of fat. That in turn can bring about poor absorption of fat, an important source of calories.
A system of rhythmic contractions known as peristalsis moves the bolus (now a more soupy mixture known as “chyme”) from the lower end of the stomach, through a sphincter called the pyloric valve, and into the small intestine in a series of small, spoon-size squirts.
The small intestine is small only in its diameter (being about one inch). In length it runs about 23 feet. Food takes from two to nine hours to move through the winding passage.
The small intestine needs three quarts of watery fluid every day to make absorption of nutrients easier. Absorption then continues in the large intestine, or colon. Half-way through the colon digestion is complete. In the second half, water is reabsorbed, leaving a mass of solid waste, consisting of undigested fibers, fat, and bacteria. In all, the colon itself is five feet long and looks like an upside-down “U.” When a section of the intestinal wall is weak, there is a tendency for a bulge or pouch to form, resulting in diverticulosis.
Many beneficial bacteria live in this section of the digestive tract. They are essential for a healthy digestion, but are also the main cause of gas.
Some common problems, like persistent diarrhea and constipation, can be symptoms of diseases such as irritable bowel syndrome and inflammatory bowel disease. These two digestive disorders can occur anywhere in the digestive tract, but show up most often in the intestines. Inflammatory bowel disease includes disorders such as Crohn’s disease or ulcerative colitis, both of which still defy lasting cures.
The food we commit to the daily journey through the digestive tract can aggravate many of its problems; and a simple change in diet can sometimes provide substantial relief. If you suffer from one of the following problems, these suggestions may prove helpful.
Leading Perpetrators of Heartburn
If you suffer attacks of heartburn, try cutting back on the foods below. Some, like spicy foods, seem obvious. Others you might never suspect.
If you’ve ever had a really bad case of heartburn, you may have been surprised and thankful to learn you weren’t having a heart attack. The gripping pain can spread into the arms, neck, face, and back, mimicking the symptoms of heart disorders such as angina. But despite its name, heartburn has nothing to do with the heart; it’s merely the result of “reflux” or backwash of acidic stomach contents into the esophagus.
Normally, the lower esophageal sphincter (LES), which separates the esophagus from the stomach, opens and closes on schedule. When food is swallowed and needs to enter the stomach, it relaxes; once the food has passed by, it tightens again. Reflux occurs when muscle pressure in the LES is relatively low. Pressure can be raised by protein and lowered by fat, alcohol, caffeinated beverages and smoking. Because LES pressure drops during pregnancy, scientists believe that fluctuating estrogen and progesterone levels also play a role.
The LES relaxes after certain foods are eaten. While this is no problem to most people, it causes painful symptoms in those prone to heartburn. When the condition becomes chronic, the inflamed lower esophagus becomes sensitive to even more types of food, which is probably the reason many people react badly to spicy food.
To manage heartburn, try the following:
|•||Drink plenty of water to soothe irritated esophageal tissues and flush acidic stomach contents back where they belong.|
|•||Eat small meals to avoid distention of the stomach.|
|•||Don’t eat within 3 hours of bedtime.|
|•||If you are overweight, shed pounds to relieve pressure on the abdomen.|
|•||Avoid constricting clothes.|
|•||If you smoke, quit.|
You can use gravity to alleviate some of the pain of a heartburn attack:
|•||Avoid bending over.|
|•||Stand up rather than lie down; don’t lie down for 3 hours after eating.|
|•||Use a 6- to 10-inch wedge under your pillow so your esophagus is higher than your stomach while you sleep.|
Heartburn can be a symptom of monosodium glutamate (MSG) allergy or sensitivity. Other symptoms include headache, warmth, stiffness, weakness, tingling, pressure, light-headedness and general stomach discomfort. A flavor enhancer used in many Chinese dishes and sold under the trade name Accent (among others), MSG has been the culprit in many vague and annoying food reactions.
Sudden abdominal pain, nausea, vomiting, and diarrhea can occur in as few as four hours or as many as 30 hours after consuming tainted food. Headaches, cold sweats, shivering and, occasionally, double vision can accompany the problem.
The most common form of food poisoning is caused by toxins released by bacteria. In badly canned foods, the bacterial invasion called botulism can cause a life-threatening emergency. In fresh foods, Salmonella organisms are usually the culprits. Bacteria get into food from infected animals, from animal excretions, or from infected humans preparing the food.
The best first aid for food poisoning is to rid yourself of the offending material by vomiting, then replace lost water and salt.
However unpleasant it may be, vomiting can save your life or at least bring relief in times of extreme digestive distress. If you swallow a poisonous substance, if you’ve eaten too much for your stomach to handle, or if the food you ate was tainted with harmful bacteria, the upper part of your stomach sends messages to the medulla of your brain. The brain then orders the pyloric valve between the stomach and the small intestine to relax. Churning in this area sends the digesting food back up into the upper stomach, and the muscles of the abdomen force the contents out of the stomach.
The mechanism of vomiting is a clear example of the close connection between the mind and the digestive system. Nerves from various parts of the body can cause vomiting when you get seasick or carsick; or when you see, smell, taste, hear or touch something unpleasant. If you have a chronic digestive disorder that is difficult to manage and you regularly experience nausea and vomiting when facing emotionally charged issues, you may benefit greatly from psychiatric counseling for your disorder.
If milk gives you discomfort, you may have a deficiency of the digestive enzyme lactase, which is responsible for processing lactose, the natural sugar in milk. Lactase splits lactose, a “disaccharide,” into the two “monosaccharides” glucose and galactose. For those people who don’t have enough lactase, the milk sugar remains undigested, or malabsorbed, and passes to the large intestine. Once here, it draws excess water and yet more sugar. The beneficial bacteria that live in the colon then rapidly ferment these sugars. Because this process produces gas and acids, lactose intolerance can cause cramps, bloating, flatulence, and diarrhea.
The process of making yogurt and cheese breaks the lactose molecule, so people who are lactose intolerant can usually eat these calcium-rich dairy products without experiencing the same painful symptoms. This biological process probably accounts for the belief that cheese and yogurt are “binding;” when people who are lactose intolerant switch to cheese or yogurt, they notice that their stools become firmer. Unfortunately, some manufacturers of soft cheeses and yogurt now add milk back into their products, bringing the levels of lactose back up. Before buying these foods, check the labels to see if the products contain active cultures, since live bacteria break down the lactose. For more on this common food sensitivity, see “When Good Food Makes You Feel Bad: Living with Allergy.”
Gluten Lurks in Unlikely Places
You’d expect to find the wheat protein gluten in baked goods, cereal, and pasta. But in tomato sauce?! Here are a few of the products in which gluten hides.
Another intolerance—to the gluten in wheat, rye, and barley—can lead to the inflammation of the intestines, called “celiac sprue.” Gluten consists of water-insoluble glutenin and soluble gliadins. The gliadins are toxic and in some people can damage the soft, gland-lined tissue of the intestinal lining (the mucosa), although the reasons for this are unknown. The damage makes it difficult for the mucosa to properly absorb nutrients.
About one of every 2,500 people has celiac disease. It is more common in women than men, and occurs most frequently in people hailing from northwestern Europe. In fact, the highest prevalence of celiac sprue is in Galway, Ireland, where one of every 300 people has the disease. It is rare among people of African, Asian, Jewish, and Mediterranean origin.
Why some people develop gluten intolerance and others don’t remains a mystery, but a recent study of Swedish children suggests the problem may begin very early in life and be related to breastfeeding habits and early exposure to cereals.
Researchers report that in the mid-1980s, there was a dramatic increase in the number of Swedish children under 2 years of age who developed gluten intolerance. This was also around the time that parents began increasing the amount of cereals they fed infants. In fact, flour consumption doubled in this age group. But around 1995, cereal consumption dropped among the very young, and when it did, so did the frequency of gluten intolerance.
The dramatic increase and drop in the incidence of the disease also seems to have paralleled changes in breastfeeding habits among Swedish mothers. In the 1980s, no more than 51 percent were nursing either partially or exclusively, but by 1997 that number had reached 76 percent.
Symptoms of gluten malabsorption include diarrhea or constipation, gas, weight loss, and fatigue. Serious cases can lead to iron-deficiency anemia or osteomalacia, a disorder of the bones caused by vitamin D deficiency. A bloated abdomen, a greasy stool, and an increased appetite are also signs of this disorder. There’s even evidence to show that gluten intolerance can mimic neurological diseases. Among a group of people suffering from a condition called idiopathic ataxia—characterized by poor muscle coordination and difficulty walking—it was discovered that more than half were sensitive to gluten.
Nutritional therapy calls for the elimination of all gluten-containing foods—that is, any product containing wheat, barley, or rye. Until recently, oats were also on the list of forbidden foods, but when gluten-intolerant patients were fed a gluten-free diet with and without oats, those eating oats did just as well as those who ate none. Their symptoms didn’t flare up and they didn’t develop nutritional deficiencies—a common problem among gluten-sensitive patients because they stop absorbing nutrients.
Completely avoiding gluten is a tall order in our society, where so many processed foods contain wheat. Wheat flour can be found in everything from ice cream, salad dressings, canned foods, instant coffee, and tea, to catsup, mustard, and most candy bars. Get into the habit of reading all food labels and checking the ingredients of processed foods. Additionally, beware of food additives, emulsifiers, or stabilizers when cooking or when dining out.
Flours made from rice, soybean, buckwheat, potato, tapioca, and corn are nontoxic and can be used by people who are gluten-intolerant. Cookbooks that can help you prepare gluten-free meals include Gourmet Food on a Wheat-Free Diet and Easy Rice Flour Recipes by Marion Wood.
Researchers have recently disproved almost all of our most long-standing beliefs about peptic ulcers—those of the stomach and upper small intestine (the duodenum). It was once thought that people under extreme stress produced more stomach acid and were therefore more prone to ulcers. Once the lesions in the stomach or intestinal wall established themselves, physicians recommended eating a bland diet and drinking milk. Now we know that an S-shaped bacterium called Helicobacter pylori (H. pylori) causes most of these ulcers. Ulcers have been shown to heal as fast on a liberal diet as on a traditional bland diet. And although drinking milk can lower stomach acid concentrations briefly, acid secretion then comes on stronger than before.
The link between bacteria and ulcers came as quite a shock to the scientific community, which held to the precept that no such organism could live in the highly acidic environment of the stomach. But the crafty H. pylori can produce a substance called urease, that breaks down urea and produces ammonia, creating a nonacidic area in which the bacterium can thrive. It is the ammonia that eats away at the mucosal layer of the stomach to produce gastric ulcers and of the upper small intestine to produce duodenal ulcers.
Experts believe that H. pylori causes 80 percent of all gastric ulcers. Other causes include genetic predisposition, smoking, and overuse of pain killers such as aspirin and ibuprofen that can weaken the mucosa and make it more susceptible to stomach acid.
Not everyone who has H. pylori in their digestive tract will get ulcers. Worldwide, an estimated three billion people are infected with the bacteria, and of this number, one in four to one in eight will get an ulcerative disease.
For most people, a course of antibiotics will cure the ulcer. But in about one in five Americans with H. pylori-induced ulcers, the problem tends to recur. To control their symptoms, this unlucky minority may need medication that suppresses acid production. There are also some nutritional steps you can take to at least manage the condition. You should also find out if you are allergic or sensitive to any foods. (See “When Good Food Makes You Feel Bad: Living with Allergy.”)
Avoid any foods or beverages which increase acid production. Even if stomach acid didn’t start the ulcer, it can make it worse and interfere with healing. Refined sugar can stimulate acid production, as can alcohol, caffeine, and even decaffeinated coffee. Contrary to popular belief, spicy foods and citrus fruits do not seem to be harmful to the majority of ulcer sufferers.
Bismuth (the active ingredient in Pepto-Bismol), a mineral that has been used for over 200 years for the treatment of indigestion and gastric problems, was recently shown to be as effective as the newest class of anti-ulcer medications, with a lower rate of recurrence. However, since regular use may cause damage to the nervous system, doctors recommend that people with ulcers take no more than 120 milligrams of bismuth four times a day before meals and at bedtime, and limit their course of treatment to six to eight weeks.
Animal studies of zinc have shown that this mineral can prevent the release of chemicals that weaken the mucosa, and that zinc can promote ulcer healing.
Licorice root with an acid removed (deglycyrrhizinated licorice) has also shown to be as effective as new anti-ulcer drugs, and it appears to protect against aspirin-induced damage to the stomach lining.
Removal of the gallbladder is the most common abdominal surgery among American adults. On average, 800,000 of the 16 to 22 million Americans with gallstones require hospitalization every year.
Gallstones, small rock-like balls of crystallized cholesterol, are formed when the delicate balance of ingredients in bile is disrupted. Bile is made by the liver and stored in the gallbladder. It is made up of bile salts, lecithin, cholesterol, and various byproducts of dead red blood cells. When the concentration of one of these elements changes, gallstones can develop. They become a real problem when they lodge in one of the bile-carrying ducts and cut off the supply of bile to the small intestine. Bile is essential for the digestion of fat.
Diets high in fat and sugar and low in fiber are most likely to promote gallbladder problems. Food sensitivities also play a role. When 69 people with gallbladder problems were placed on a diet that eliminated suspect foods, all saw their symptoms disappear. Ninety-three percent of the people experienced a return of their symptoms after they ate eggs; 64 percent after they ate pork, and 52 percent after they ate onions.
In general, if you suffer from gallstones you should:
|•||Stick to a low-fat, low-sugar, high-fiber diet|
|•||Lose weight (if you are overweight)|
|•||Always eat breakfast|
|•||Avoid any foods that you notice cause your symptoms to flare up|
The large intestine is a smooth-walled muscular tube that contracts three to four times a day, usually during or just after eating. This contraction moves the intestinal contents towards the rectum for eventual disposal. Fiber in the diet strengthens the contractions and keeps muscular walls in tone.
When the diet lacks sufficient fiber, the walls of the lower intestine thicken, the passage narrows, and the relative pressure on the walls becomes greater. If pressure is high and certain sections of the walls are weaker than others, they may begin to bulge. The outpouchings that occur in this way are called diverticula, and the condition which arises is called diverticulosis. When the diverticula become inflamed, as they do in roughly five percent of patients, a life-threatening condition known as diverticulitis can occur.
The cause of diverticula is unknown, but much evidence points to diet. Diverticula were medical curiosities until the early 1900s, when the milling of wheat—which removes much of the fiber from flour—became widespread and the fiber content of most breads plunged 80 percent. Refined sugars also became commonplace during this period, as exports made their way throughout the world. Since then, the incidence of diverticulitis has risen dramatically. To illustrate, consider what happened in England during World War II: As imports declined, the people had to eat only what they could produce locally—more grain and less refined sugar. The forced change in diet then put a halt to the rising rate of diverticulitis-induced death.
Diverticula occur most often in older people; they are uncommon in people less than 40 years old. One in every four people over 60 has the outpouchings; once past 80, one in every two people has them. Scientists presume either that it takes many years for the diverticula to develop or that the colons of older people are less likely to withstand the intestinal pressure without herniating, or both.
Diverticulosis does not lead to colon cancer, but recent studies show that the chances of both rise together—probably because both are promoted by a low-fiber diet.
Symptoms of diverticulitis include alternating constipation and diarrhea, pain and tenderness in the colon, and gassiness. If you have this disease, you should eat a high-fiber diet to thwart its progression, but antibiotics or even surgery may become necessary. A high-fiber diet may also prevent the disease from occurring.
Medications That Cause Diarrhea and Constipation
Certain medications can disrupt the efficient balance of the digestive system, causing diarrhea and constipation, or holding food in your stomach longer than usual. Antibiotics can kill beneficial bacteria in your large intestine, allowing the unrestrained growth of a bacterium called Clostridium difficile. This bacterium inflames the intestinal wall making it “weep” excess water and mucous, resulting in watery stools. Antibiotics known to cause this problem include ampicillin, clindamycin, and the cephalosporins.
Overuse of magnesium antacids and laxatives can also cause chronic diarrhea. In fact, surreptitious laxative abuse has been found to be one of the major causes of diarrhea, especially in women who presumably are taking them to control their weight. (All for naught, apparently. A study of Correctol tablet use, found that the laxative decreased calorie absorption by only five percent.)
Oddly enough, overuse of laxatives can have the opposite effect. By damaging the nerves of the colon, they can cause chronic constipation. In addition to laxatives, other common drugs known to cause constipation are:
Adding beneficial bacteria back into your system can be helpful, and can be achieved by supplementing your diet with Lactobacillis Acidophilus, sold over the counter at most drug stores.
Antidepressants and drugs used to treat Parkinson’s disease can also slow down stomach activity, causing a feeling of fullness, bloating, heartburn, or indigestion, pain in the mid-abdomen, nausea, and vomiting of food eaten hours before. To help prevent these side effects, don’t recline for at least an hour after eating, eat small meals frequently, and consider asking your doctor to change the dosage of your prescription.
Gas may be a social embarrassment, but it is both a necessary part of the digestive process and an important warning sign of various disorders. About two pints of gas are normally produced in the human gastrointestinal tract daily, more when carbohydrate-rich foods (like beans) are eaten. If you are plagued by excessive gas without eating such foods you may have a malabsorption disorder in which the starches and sugars you eat are not sufficiently digested in the small intestine and reach the colon in large amounts.
By the time food enters the large intestine, most of it has been digested. Bacteria inhabiting this segment of the digestive tract then break down what remains—usually indigestible cellulose and other carbohydrates. As the bacteria go about producing food for themselves, they are also releasing nutrients such as vitamins B and K for their human host. When they act upon carbohydrates, however, the fermentation that takes place produces gases such as hydrogen, carbon dioxide, and methane. It makes sense, then, that a diet high in sugar, starch, and fiber can cause excess gas and even abdominal discomfort.
If you have excess gas due to malabsorption or some other disorder, it is usually because food is being rushed from the small to the large intestine, where undigested carbohydrates are being broken down too quickly for the colon to absorb. Pain and bloating with accompanying gas are the result.
To remedy the problem, try these measures:
|•||Sugar: Avoid non-absorbable sugars such as those found in beans and peas. Also, avoid lactose (milk sugar), if you think you might be lastase-deficient.|
|•||Fructans: Avoid carbohydrates found in artichokes, onions, leeks, and chicory, because the small intestine cannot digest them.|
|•||Starch: Try to eat starches that are cooked and still hot, and stick to white bread. Rice starch is almost completely digestible. Avoid unmilled grains and seeds, unripe bananas, incompletely cooked potatoes, and cooked and cooled starches other than cereal starches.|
|•||Fiber: Keep your intake of fiber at the average or even below-average level. Since fiber is so beneficial to other digestive processes, however, you may want to try doing without this step.|
When food residue is rushed through the intestines, as when the lining is irritated or inflamed by infection, the colon does not have sufficient time to absorb excess water. As a result, runny stools may occur several times a day. Diarrhea can also develop when too much fluid is drawn into the intestines, due to illness outside the digestive system. Conversely, when food residue stays in the large intestine for extended periods of time, too much water is absorbed back into the body, and hard stools result every few days.
The most common nutritional therapy for diarrhea is simply to replace water and electrolytes, a process called rehydration therapy. The World Health Organization developed a liquid preparation to treat cholera and tropical diseases, but the principles apply to anyone suffering from acute diarrhea. Here is a home brew you can try: Dissolve 1/4 teaspoon salt and four heaping tablespoons of sugar in 150 milliliters (2/3 cup) of boiling water. Add 150 milliliters of fresh orange juice and 200 milliliters (7/8 cup) of tap water. This brew will provide needed amounts of sodium, potassium, and sucrose. Avoid anti-diarrheals, such as Lomotil, Donnagel, and Imodium.
The acute diarrhea caused by gastric infections and the diarrhea often triggered by antibiotics can both be relieved by taking probiotics. This term refers to a group of foods and nutritional supplements that contain beneficial bacteria like lactobacillus. Fermented dairy products such as yogurt and supplements containing Lactobacillus rhamnosus, for instance, have been found effective in treating the diarrhea that accompanies rotavirus infection, a common problem in newborns. Similarly, several clinical trials have shown that probiotic formulas can relieve the diarrhea that develops when antibiotics destroy beneficial intestinal bacteria along with the germs, a problem that afflicts as many as one out of every five patients taking antibiotics.
Some studies suggest that feeding fermented food products to children can also prevent diarrhea. One group of researchers, for example, found that the bacteria Bifidobacterium bifidum and Streptococcus thermaphilus reduced the threat of diarrhea among babies admitted to the hospital with rotavirus infection. A second experiment in Peru found that children drinking a milk enriched with lactobacillus had fewer episodes of diarrhea.
There seems to be a clear association between diet and constipation. Dietary fiber, while it is no panacea for all cases of constipation, can increase stool weight, frequency, and water content. Different fibers have different effects; the soluble fibers containing pectin and mucilage (found in citrus fruits and bananas) have the least effect on the bowels, and fibers in foods such as bran have the most. Corn bran relieves constipation more effectively than wheat bran. Foods containing cellulose (bran, whole grain flour, some fruits and vegetables) survive the digestive process better than the noncellulose fiber in oatmeal, breakfast cereal, and sesame seeds.
If you eat a diet low in fiber, it might be advisable to add bulk slowly. The best way is to switch from white bread to whole wheat bread. You could also add half a cup of bran to your food daily, and increase your intake half a cup at a time over a few weeks until you reach two cups daily.
This disorder, also known as spastic colon or irritable colon, has no known cause. People whose family members have the problem are more likely to develop it. Symptoms include constipation (usually with abdominal pain) or diarrhea (usually without pain), bloating, gas, passage of non-bloody mucous, and a sensation of incomplete rectal emptying. Constipation and diarrhea can be intermittent, and the stools may be pellet-like during the constipation phase. The symptoms are similar to those of inflammatory bowel disease but no inflammation is present.
Irritable Bowel Syndrome frequently accompanies psychological disorders, leading some researchers to suspect an emotional origin. Men and women with the disorder often score high in the areas of anxiousness and depression on psychological personality tests, and tend to be more neurotic than people without the disorder. In fact, one of the most common prescriptions for the problem is for antidepressants.
Since symptoms of the disorder arise from spasms of the bowel muscles, some experts thought that a high-fiber diet—which increases the fecal bulk in the colon and, therefore, acts as a type of cushion—might alleviate some of the symptoms. However, in a recent study, people who supplemented their diets with fiber and those who didn’t experienced the same results. Another study did find that a high-fiber diet gave relief to patients with hard stools or constipation, but not to those with diarrhea, bloating, and gas.
If you suspect that certain foods aggravate your symptoms ask your doctor about an elimination diet. Many with Irritable Bowel Syndrome react poorly to excessive caffeine and alcohol. Others do better if they eliminate gas-forming legumes like soybeans or peanuts, or lactose-rich dairy foods. (Keep in mind, however, that those who eliminate calcium-rich milk products will likely need a calcium supplement to prevent a deficiency.)
Another possible dietary culprit is sorbitol, a sweetening agent found in many candies and jellies labeled “dietetic.” This sugar substitute is known to cause diarrhea in sensitive persons and may trigger the problem in people with Irritable Bowel Syndrome.
One way to determine which foods may be triggering symptoms is to keep a food diary that tracks everything you eat for a two-week period and lists intestinal symptoms during that time. Analyzing the diary may turn up patterns that incriminate certain foods.
If all else fails, you can also give alternative medicine a try. A carefully designed clinical trial recently concluded that Chinese herbal medicine may be of some value in controlling the symptoms of Irritable Bowel Syndrome. When patients were given either dummy capsules or capsules containing a combination of herbs, those on the herbal formula reported significantly more improvement and said the disease was less likely to interfere with everyday life. The herbal formula contained such herbs as Dang Shen, Huo Xiang, Fang Feng, and Yi Yi Ren.
There are two million Americans with either ulcerative colitis or Crohn’s disease, the two major forms of Inflammatory Bowel Disease. The cause of the disorder is unknown (although there does appear to be some hereditary basis) and no specific preventive or curative measures stand out above the rest, making Inflammatory Bowel Disease one of the most difficult diseases to treat. Symptoms of both ulcerative colitis and Crohn’s disease include abdominal pain and diarrhea. People suffering from these conditions—often adolescents and young adults—are sometimes malnourished since they may not have much of an appetite and may be unable to absorb sufficient nutrients from the intestines. In fact, some patients need injections of nutritional supplements in addition to the foods they eat.
Ulcerative colitis results from the development of ulcers on the lining of the large intestine. As with gastric ulcers, a bacterium might be responsible, although this is currently just a theory. Dr. Barry Marshall, the Australian doctor who upset the medical community by showing the link between H. pylori and gastric ulcers (he actually swallowed some of the bacteria to prove his point), suspects that ulcerative colitis is related to some infectious process because it affects only the colon and has the same characteristics as a bacterial infection.
Physicians sometimes prescribe a diet low in residue along with multivitamin supplements for ulcerative colitis. Foods to favor, and those to avoid, are listed in the box nearby.
A small study of people with mild to moderate ulcerative colitis showed recently that treatment with omega-3 fatty acids could improve symptoms. Omega-3s have known anti-inflammatory effects. Seven of 10 patients reported either moderate or marked improvement in their symptoms; this finding was borne out by a slightly larger study of both ulcerative colitis and Crohn’s disease patients. The omega-3s worked only for the ulcerative colitis group, however. And in a follow-up study that compared omega-3 fatty acids to the prescription drug sulfasalazine, the drug proved more effective.
A recent study suggests that patients who have undergone surgery for ulcerative colitis may respond to nutritional therapy as well. Among patients with pouchitis, an inflammation of the reservoir created during intestinal surgery, those taking 6 grams a day of an oral probiotic containing various beneficial bacteria—lactobacillus, bifidobacteria, and Streptococcus thermaphilus—were less likely to relapse than those taking a dummy medication.
Unlike ulcerative colitis, Crohn’s disease can be found anywhere along the digestive tract, although it occurs most often in the lower small intestine. In the diseased areas, ulcers dot the thickened intestinal wall, often deepening to the point of perforation. Between these areas, the lining is relatively healthy. Young people are more likely to have Crohn’s disease than older adults; its peak occurrence is in the 30s and 40s. It is most prevalent among white people and those of Jewish origin.
The common complaints of this disorder—abdominal pain and diarrhea—occur in 80 to 90 percent of cases. When the disease occurs in the small intestine, rather than elsewhere in the digestive tract, it may also cause weight loss, anorexia, fever, nausea and vomiting, fatigue, and intestinal obstruction.
There is no medical agreement on a specific diet for the treatment of Crohn’s disease, but several small studies have uncovered certain measures that may be helpful to some individuals. For example, it is known that people with the disorder tend to eat more sugar than those who are disease-free, suggesting that a diet low in refined carbohydrates may be useful as a preventative measure. Refined carbohydrates include refined sugars such as cane, beet, and corn sugar, white (bleached, enriched) wheat flour; and white (polished) rice. Some studies even indicate that a diet rich in fiber and unrefined carbohydrates can relieve the symptoms of Crohn’s disease and reduce the number and duration of hospital stays. Researchers also suggest eating foods low in residue and high in protein, especially lean meat and liver (see the box on “Best (and Worst) Choices for Inflammatory Bowel Disease”).
Another nutritional treatment that has met with some success is an elemental diet. This is a specially prepared formula in which all the complex food components are broken down into their simplest, most easily digested forms. Proteins, for instance, are converted into their amino acid building blocks. While these special formulas are expensive and not all that appetizing, for those who can tolerate them, they’re about as effective as the steroid drugs that are sometimes prescribed for this condition.
If all else fails—for Crohn’s disease or any other digestive ailment, remember that emotions can also play havoc with the digestive system. Previously untreatable or unexplainable ailments of the digestive tract have sometimes spontaneously disappeared after seemingly unrelated personal issues were resolved. Don’t hesitate to seek professional assistance. Psychotherapy, biofeedback, behavior modification, and hypnosis may all be helpful in relieving gastrointestinal disorders.
Best (and Worst) Choices for Inflammatory Bowel Disease
Many doctors feel that diet doesn’t make any difference in this puzzling, frustrating disease. However, when doctors do prescribe a special diet, it usually involves plenty of these low-residue, easily absorbed foods:
Avoid these high residue foods: