Dietary Relief for Bowel Problems
Affecting one in five adults, irritable bowel syndrome causes cramps, bloating and changes in bowel habits.
Last year, the primary drug used to treat the illness, Lotronex, was voluntarily removed from the market amid fears of life-threatening side effects. Doctors are now awaiting FDA approval of another drug, Zelnorm.
Individual drugs for IBS may come in and out of vogue, but there has never been a standard way of treating this painful condition, the causes of which continue to baffle doctors.
Amid the confusion over possible causes and best treatment options, however, one factor remains clear: Diet plays a role. According to the American Gastroenterological Assn., the act of eating stimulates movement in the bowel, the strength of the response often related to the number of calories and fat in a meal.
For these reasons the association advises small, frequent meals containing low-fat, high-carbohydrate foods. It also recommends avoiding large amounts of alcohol and caffeine.
Work emerging from Cambridge, England, suggests another rationale for making dietary changes.
Dr. John Hunter and colleagues have been researching the link between diet and IBS for more than 20 years. “IBS may be caused through a change in gut bacteria when so-called good, or probiotic, bacteria are diminished leaving an overgrowth of bad bacteria,” Hunter says. “These bad bacteria increase levels of normal fermentation in the colon resulting in excess production of hydrogen and methane gases, which we feel could be responsible for bloating and disturbances in the gut’s normal movement patterns.”
Hunter has identified many potential causes for such changes in colon flora and subsequent problems with fermentation, such as food poisoning, gastroenteritis and antibiotics. Anesthetics, radiation from X-rays and raised progesterone levels in the premenstrual phase have a similar effect.
These changes in fermentation patterns appear to trigger intolerances to certain foods, causing part of the food to pass undigested through the stomach and small intestine and into the colon. Here it too undergoes fermentation, the result being yet more gas production and changes in bowel movements.
Work by the Cambridge team published in the Lancet medical journal revealed that, in patients with fermentation problems, the production of hydrogen and methane gases and the symptoms were reduced when following an elimination diet.
Such diets, which require the removal of various foods over a two-week period, rely heavily on rice, plain meat and fish and soy products before the reintroduction of eliminated foods and assessment of symptoms. Hunter has found that removing wheat appears to have the greatest effect, followed by removal of dairy products, corn, coffee, tea, chocolate, tea and yeast.
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Amanda Ursell, a dietitian, is a London-based freelance journalist. Her column appears twice a month. She can be reached at amanda@ursell.com.
