Endnotes to Eating for Irritable Bowel Syndrome
1. Several stress-reduction treatments have been studied in patients with IBS, including cognitive-behavioral treatment, hypnosis, relaxation, and biofeedback. They appear to be effective in reducing abdominal pain and diarrhea but not constipation. It is not known whether improvement in IBS symptoms relates to changes in gastrointestinal physiology or in the psychological interpretation of enteroceptive sensation. A positive response is associated primarily with patients who relate symptom exacerbations to stressors, and have a waxing and waning of symptoms rather than chronic pain. There is no comparative data to determine which treatment is superior. (Guidelines of the American Gastroenterological Association).2. Levsin, Bentyl, Donnatol, Pro-Banthine, Librax, Modulon, Sinequan.
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3. Lotronex, by Glaxo Wellcome is the first of this new generation of agents being studied specifically for the treatment of multiple symptoms of IBS. The drug works as a potent and selective 5-HT3 antagonist. The neurotransmitter serotonin and 5-HT3 receptors that are extensively distributed in the human gastrointestinal tract are thought to play a role in increasing the sensation of pain and affecting bowel function in patients with IBS. While the precise mechanism of action of Lotronex is not yet fully understood, one hypothesis is that Lotronex blocks the action of serotonin at 5-HT3 receptor sites in the enteric nervous system. Lotronex works best in women, and in patients who have diarrheas their primary symptom. 4. Participate, Quarterly Bulletin of the IFFGD, Vol 8, No. 3, Fall 1999, p. 7. 5. Nearly 40% of women with IBS report experiencing abdominal pain they describe as "intolerable." (Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome.) 6. International Foundation for Functional Gastrointestinal Disorders 7. American Gastroenterological Association. 8. Although 58% percent of U.S. physicians think IBS is easy to diagnose, women with IBS see an average of three physicians over a three-year period before they receive a clear-cut diagnosis. (Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome.) 9. Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome. 10. Celiac sprue is a genetic, autoimmune disorder that damages the small intestine. People with celiac sprue cannot tolerate gluten, a protein found in wheat, rye, barley, and possibly oats. A simple blood test that measures the levels of gluten-antibodies can diagnosis celiac sprue, and the diagnosis can be confirmed with an intestinal biopsy that checks for tissue damage. In the United States, the average time between the onset of celiac sprue symptoms and diagnosis is ten years. The only treatment for this disorder is a gluten-free diet. 11. It is crucial that a person with an inflammatory bowel disease not be misdiagnosed with IBS, particularly since many doctors offer no help to their IBS patients beyond urging them to "eat more fiber." Should a person with Crohn's or Ulcerative Colitis follow this advice a sudden increase in their ingestion of insoluble fiber can result in bowel obstructions requiring hospitalization and surgery. 12. Diagnosis of IBS requires a physical examination and the following studies: complete blood count; sedimentation rate; chemistries; stool for ova, parasites, and blood; and flexible sigmoidoscopy or colonoscopy or barium enema with sigmoidoscopy if older than 50 years; gynecological exam with CA-125 blood test. Other diagnostic studies should be minimal and will depend on the symptom subtype. For example, in patients with diarrhea-predominant symptoms, a small bowel radiograph to rule out Crohn's disease, or lactose/dextrose H2 breath test. For patients with pain as the predominant symptom, a plain abdominal radiograph during an acute episode to exclude bowel obstruction and other abdominal pathology. For patients with indigestion, nausea, and bloating, an abdominal ultrasound to rule out gallstones. (Guidelines of the American Gastroenterological Association). 13. "IBS is a real, chronic medical condition with painful and potentially debilitating symptoms," says Lin Chang, MD, co-director of the Neuroenteric Disease Program at the University of California at Los Angles Medical School. "Research suggests that IBS stems from a physiologic abnormality, and is clearly not a psychosomatic disorder." (Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome.) 14. IBS Information from The National Digestive Diseases Information Clearinghouse (NDDIC). The NDDIC is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, under the U.S. Public Health Service. The clearinghouse, authorized by Congress in 1980, provides information about digestive diseases and health to people with digestive diseases and their families, health care professionals, and the public. The NDDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient organizations and government agencies to coordinate resources about digestive diseases. 15. 87% of U.S. doctors admit that physicians need better education about IBS. (Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome.) 16. International Foundation for Functional Gastrointestinal Disorders 17. Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome. 18. Women with active IBS take three times as many sick days as women in the general public, miss work or school twice as often, and almost one in four are forced to allow extra time for their daily commute due to abdominal symptoms. (Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome.) 19. International Foundation for Functional Gastrointestinal Disorders 20. On average, doctors who treat IBS rate the pain felt by their IBS patients as being significantly less severe than the patients themselves report. Furthermore, a majority of doctors say that while IBS may be distressing, it is not a serious medical condition, despite the fact that three out of ten women with IBS report having been hospitalized for their abdominal symptoms at some point. (Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome.) 21. More than one in four women with IBS say that their doctor does not understand how much pain or discomfort they feel and that there is no point in consulting their doctor about their symptoms. (Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome.) 22. Unfortunately, nearly a third of all U.S. physicians mistakenly believe that IBS is primarily a psychological problem. (Citation from the largest, most comprehensive national survey ever conducted on IBS, July/August 1999, by Schulman, Ronca and Bucuvalas, Inc., funded by Glaxo Wellcome.) 23. 1. Feskanich D, Willet WC, Stampfer MJ, Colditz GA. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Am J Public Health 1997;87:992-7. 2. Cumming RG, Klineberg RJ. Case-control study of risk factors for hip fractures in the elderly. Am J Epidemiol 1994;139:493-505. 3. Huang Z, Himes JH, McGovern PG. Nutrition and subsequent hip fracture risk among a national cohort of white women. Am J Epidemiol 1996;144:124-34. 4. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. N Engl J Med 1995;332:767-73. 24. American Journal of Clinical Nutrition, March 1983.25. 1. Finn SC. The skeleton crew: is calcium enough? J Women's Health 1998;7(1):31-6. 2. Nordin CBE. Calcium and osteoporosis. Nutrition 1997;3(7/8):664-86. 3. Reid DM, New SA. Nutritional influences on bone mass. Proceed Nutr Soc 1997;56:977-87. 26. Tucker KL, Hannan MR, Chen H, Cupples LA, Wilson PWF, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr 1999;69:727-36.27. Prince R, Devine A, Dick I, et al. The effects of calcium supplementation (milk powder or tablets) and exercise on bone mineral density in postmenopausal women. J Bone Miner Res 1995;10:1068-75. 28. 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Am J Clin Nutr 1990;51:489-91. 2. Karjalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. N Engl J Med 1992;327:302-7. 33. Skoldstam L, Larsson L, Lindstrom FD. Effects of fasting and lactovegetarian diet on rheumatoid arthritis. Scand J Rheumatol 1979;8:249-55.34. Dr. David L. Katz, Yale School of Medicine, New Haven, Connecticut, presenting findings at the 1999 meeting of the American College of Nutrition, held in Washington, DC |
