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Gastroenterol Clin North Am. 1989 Sep;18(3):513-24.
Nutritional therapy of irritable bowel syndrome.
Friedman G.
Mount Sinai School of Medicine, New York, New York.
Nutritional factors relative to IBS include diagnostic and therapeutic considerations. Etiologically, foods do not cause IBS. A small percentage of patients with childhood allergic diatheses, usually in association with atopic dermatitis and asthma, may be intolerant to one or more of wheat, corn, dairy products, coffee, tea, or citrus fruits. Diagnostically, many patients labeled as IBS subjects are in fact intolerant to the ingestion of lactose-containing foods, sorbitol, fructose, or combinations of fructose and sorbitol. A precise dietary history will characterize this group. Taken in its broadest context, IBS involves the entire hollow tract inclusive of esophagus, stomach, small bowel, and colon. The symptomatic presentation relative to the hollow organ involved allows the selection of dietary manipulations that may help to reduce symptoms. Gastroesophageal reflux, a consequence of low LES pressure in some IBS patients, may be treated with the elimination of fatty foods, alcohol, chocolate, and peppermint. Delayed gastric emptying may be helped by the elimination of fatty foods and reduction of soluble fiber. Aberrant small bowel motor function may be ameliorated by reduction of lactose, sorbitol, and fructose and the addition of soluble fiber. Gas syndromes may be improved by reduced intake of beans, cabbage, lentils, legumes, apples, grapes, and raisins. Colonic motor dysfunction may be overcome by the gradual addition of combinations of soluble and insoluble fiber-containing foods and supplements. The selective use of activated charcoal and simethicone may be helpful.
Publication Types:
Review
Review, Tutorial
PMID: 2553606 [PubMed - indexed for MEDLINE]
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Note: Calcium polycarbophil is sold as Equalactin and Fibercon
Aliment Pharmacol Ther. 1993 Feb;7(1):87-92.
Calcium polycarbophil compared with placebo in irritable bowel syndrome.
Toskes PP, Connery KL, Ritchey TW.
Division of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville 32610.
Calcium polycarbophil was compared with placebo in 23 patients with irritable bowel syndrome in a six-month, randomized double-blind crossover study. Patients received polycarbophil tablets at a dosage of 6 g/day (twelve 0.5-g tablets) or matching placebo tablets. At study end, among patients expressing a preference, 15 of 21 (71%) chose polycarbophil over placebo for relief of the symptoms of irritable bowel syndrome. Statistically significant differences favouring polycarbophil were found among the following patient subgroups: 15 (79%) of 19 with constipation: all six with alternating diarrhoea and constipation; 13 (87%) of 15 with bloating: and 11 (92%) of 12 with two or more symptoms. Polycarbophil was rated better than placebo in monthly global responses to therapy. Patient diary entries showed statistically significant improvement for ease of passage with polycarbophil. Polycarbophil was rated better than placebo for relief of nausea, pain, and bloating. The data suggest that calcium polycarbophil can benefit irritable bowel syndrome patients with constipation or alternating diarrhoea and constipation and may be particularly useful in patients with bloating as a major complaint.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 8439642 [PubMed - indexed for MEDLINE]
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Br J Nutr. 2001 Mar;85 Suppl 1:S23-30.
Beneficial health effects of low-digestible carbohydrate consumption.
Scheppach W, Luehrs H, Menzel T.
Department of Medicine, University of Wuerzburg, Germany. w.scheppach@medizin.uni-wuerzburg.de
Low-digestible carbohydrates represent a class of enzyme-resistant saccharides that have specific effects on the human gastrointestinal tract. in the small bowel, they affect nutrient digestion and absorption, glucose and lipid metabolism and protect against known risk factors of cardiovascular disease. In the colon they are mainly degraded by anaerobic bacteria in a process called fermentation. As a consequence, faecal nitrogen excretion is enhanced, which is used clinically to prevent or treat hepatic encephalopathy. Low-digestible carbohydrates are trophic to the epithelia of the ileum and colon, which helps to avoid bacterial translocation. Short-chain fatty acids are important fermentation products and are evaluated as new therapeutics in acute colitis. They are considered in the primary prevention of colorectal cancer. The bifidogenic effect of fructo-oligosaccharides merits further attention, Unfermented carbohydrates increase faecal bulk and play a role in the treatment of chronic functional constipation, symptomatic diverticulosis and, possibly, the irritable bowel syndrome. In conclusion, low-digestible carbohydrates may play a role in the maintenance of human digestive health. However, the strength of evidence differs between disease entities.
Publication Types:
Review
Review, Tutorial
PMID: 11321025 [PubMed - indexed for MEDLINE]
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Scand J Gastroenterol. 2000 Oct;35(10):1048-52.
Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers.
Ledochowski M, Widner B, Bair H, Probst T, Fuchs D.
Dept. of Clinical Nutrition, Institute of Medical Chemistry and Biochemistry, University of Innsbruck, Austria.
BACKGROUND: Fructose malabsorption is characterized by the inability to absorb fructose efficiently. As a consequence fructose reaches the colon where it is broken down by bacteria to short fatty acids, CO2 and H2. Bloating, cramps, osmotic diarrhea and other symptoms of irritable bowel syndrome are the consequences and can be seen in about 50% of fructose malabsorbers. We have previously shown that fructose malabsorption is associated with early signs of mental depression and low serum tryptophan concentrations. It was therefore of interest whether a fructose-reduced diet could not only improve gastrointestinal complaints but also depressive signs seen in fructose malabsorbers. METHODS: Fifty-three adults (12 males, 41 females), who were identified as fructose malabsorbers according to their breath-H2 concentrations, filled out a Beck's depression inventory-questionnaire, and a questionnaire with arbitrary scales for measurement of meteorism, stool frequency and quality of life for a 4-week period before dietary intervention and 4 weeks after dietary change as for fructose- and sorbitol-reduced diet. RESULTS: Depression scores were reduced by 65.2% after 4 weeks of diet (P < 0.0001), and there was a significant reduction of meteorism (P < 0.0001) and stool frequency (P < 0.01). Improvement of signs of depression and of meteorism was more pronounced in females than in males. CONCLUSION: Fructose- and sorbitol-reduced diet in subjects with fructose malabsorption does not only reduce gastrointestinal symptoms but also improves mood and early signs of depression.
Publication Types:
Clinical Trial
PMID: 11099057 [PubMed - indexed for MEDLINE]
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Am J Gastroenterol. 1989 Apr;84(4):375-8. Related Articles, Links
Intestinal gas production from bacterial fermentation of undigested carbohydrate in irritable bowel syndrome.
Haderstorfer B, Psycholgin D, Whitehead WE, Schuster MM.
Division of Digestive Diseases, Francis Scott Key Medical Center, Baltimore, Maryland.
The relationship between abdominal pain and bowel gas from bacterial fermentation of undigested carbohydrate was investigated in nine patients with irritable bowel syndrome (IBS), six lactose malabsorbers, and 11 asymptomatic controls. All subjects took breath samples and marked analog scales for abdominal pain, bloating, and psychological stress hourly during all waking hours for 7 days. Breath samples were analyzed for hydrogen concentration within 3 days, and the concentration was corrected for storage time. Symptoms of pain and bloating were significantly more common in IBS patients than in lactose malabsorbers or normal controls, and pain was significantly correlated with bloating in IBS patients. Breath hydrogen concentration was similar in all three groups, and breath hydrogen was not correlated with pain ratings in IBS patients. Thus, abdominal pain may be related to bloating from gastrointestinal gas, but bacterial fermentation cannot be the cause of such gas. The most likely source is swallowed air. This study also demonstrates the feasibility of monitoring hydrogen production in the bowel in field studies by having subjects collect hourly breath samples.
PMID: 2929557 [PubMed - indexed for MEDLINE]
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Journal of Paediatrics and Child Health
Volume 39 Issue 5 Page 329 - July 2003
doi:10.1046/j.1440-1754.2003.00152.x
Cows milk consumption in constipation and anal fissure in infants and young children
F Andran 1, S Day 1, E Mete2
Objective: To examine daily cows milk consumption and duration of breastfeeding in infants and young children with anal fissure and constipation.
Methods: Two groups of 30 consecutive children aged between 4 months and 3 years were evaluated retrospectively. Group I comprised children with chronic constipation and anal fissure in whom surgical causes were excluded, and group II comprised normal children. The daily consumption of cows milk, duration of breastfeeding and other clinical features of the children were investigated
Results: The mean daily consumption of cows milk was significantly higher in group I (756 mL, range 2001500 mL) than group II (253 mL, range 01000 mL) (P < 0.001). Group I children were breastfed for a significantly shorter period (5.8 months, range 018 months) than group II (10.1 months, range 224 months) (P < 0.006). The odds ratios for the two factors children consuming more than 200 mL of cows milk per day (25 children in group I, 11 children in group II) and breastfeeding for less than 4 months (16 children in group I, 5 children in group II) were calculated to be 8.6 (95% confidence interval [CI]: 0.230.74, P = 0.0005) and 5.7 (95% CI: 0.370.66, P = 0.007), respectively.
Conclusions: Infants and young children with chronic constipation and anal fissure may consume larger amounts of cows milk than children with a normal bowel habit. Additionally, shorter duration of breastfeeding and early bottle feeding with cows milk may play a role in the development of constipation and anal fissure in infants and young children.
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Water Works
Health Sciences Institute e-Alert
September 16, 2003
You've probably heard that dietary fiber is good for your
heart. But if you've been eating lots of whole wheat bread
and high-fiber cereal in hopes that you're doing your
cardiovascular system a favor, then you may have been barking up the wrong tree.
Two recent studies reinforce previous research that revealed a clear relationship between dietary fiber and heart health.
And the studies show that choosing your fiber sources
carefully can make all the difference. Because there are two types of fiber, and while both are good for you, one has a more positive effect on your heart than the other.
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Fiber chores
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There's no need to stop the presses for the "news" that
dietary fiber is good for you. Low fiber intake has been
associated with an increased risk of a variety of cancers
(including breast and colon cancers), and I think it would be a very rare HSI member who was not aware that dietary fiber helps maintain a healthy digestive system.
All dietary fibers are classified as either water-soluble or insoluble. And because water-soluble fibers have been shown to support cardiovascular health, a team of researchers at Tulane University studied the dietary and medical records of nearly 10,000 subjects enrolled in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study (NHEFS) looking for correlations between water-soluble fiber intake and coronary heart disease (CHD).
All subjects were disease-free when the study began. During
an average follow-up period of 19 years, 1843 cases of CHD
were recorded. Examination of the dietary records showed that subjects with the highest intake of insoluble fiber
(approximately 21 grams per day) had about 12 percent lower
risk of developing CHD as those with the lowest intake
(approximately 6 grams per day).
When the same records were compared for water-soluble fiber
intake, subjects with the highest intake of this fiber
(approximately 6 grams per day) had a 15 percent lower risk
of developing CHD, compared to those with the lowest intake
(less than one gram per day).
------------------------------------------------------------Cereal killer
Another recent study among almost 1,000 heart patients in
Milan, Italy, produced conclusions similar to the Tulane
study.
Dietary factors were assessed in interviews that showed that higher fiber intake reduced the risk of heart attack by well over 25 percent. But among those who had the highest intake of fruit and water-soluble fiber, heart attack risk was reduced by an impressive 36 percent.
One surprising fact emerged from the collected data: Those
with the highest intake of cereal fiber actually increased
their heart attack risk by more than 10 percent. This was
attributed to the fact that the sources of this type of fiber appeared to be refined grains. It's no secret to most of us that many food products claim to be "whole grain" or "whole wheat," but actually contain very little of either.
--------------------------------------------------------------
Go to the source
--------------------------------------------------------------
Most people don't eat enough unrefined, water-soluble fiber
to produce the positive results shown in the Milan and Tulane studies. But good quality water-soluble fiber is easy to come by when a little care is taken to find unrefined sources of these foods:
* Fruits, including oranges, peaches, apples, and grapes
* Vegetables, including carrots, squash, and corn
* Nuts and seeds (in particular, psyllium seeds)
* Legumes, including peanuts, lentils, peas, and kidney,
black, and pinto beans
* Oats and barley
Some people add fiber supplements to their diets, but William Campbell Douglass, M.D., has warned against using these supplements and eating fiber-enriched food, stating that the total effect they may have on the human body is still unknown and potentially dangerous. Dr. Douglass compares fiber-enriched foods to trying to make a silk purse out of a sow's ear, noting that, "adding fiber to foods with refined carbohydrates and artery clogging animal fats isn't going to make these already unhealthy foods any less bad for you."
Exactly so. Especially when it's so easy to find plenty of
water-soluble fiber foods in your neighborhood grocery store.
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Milk Slows Recovery from Bowel Surgery
Milk slows down recovery from bowel surgery, according to a study presented at the annual meeting of the American Society of Colon and Rectal Surgeons.
The study, led by Dr. L. Peter Fielding of York Hospital, in York, PA, compared patients given a dairy-free diet to others given a "standard" hospital diet. The dairy-free diet cut the incidence of diarrhea from 32 percent to 5 percent, and shortened the recovery from ten days to seven, cutting hospital costs from $10,337 to $6,751.
About 65,000 people undergo bowel surgery each year. The researchers estimated that if all hospitals instituted the diet change, they would save $250 million annually.
Lactose intolerance (an inability to digest the milk sugar lactose) may not be the only reason people benefit from the diet change. Both the fat and the protein in dairy products can affect digestive function.
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Fibre and breast cancer.
Gerber M.
Cancer Research Center, INSERM-CRLC, Montpellier, France.
The strength of the hypothesis that fibre reduces the risk of breast cancer is its biological plausibility, which is supported by experimental and interventional findings and by the coherence of observational studies. However, at least half the available epidemiological studies have failed to show a decreased risk in breast cancer for an increased fibre intake. But intervention studies taking the plasma concentration of oestrogens as an end-point showed significantly lower levels of breast cancer in women with a high-fibre and low-fat diet than in women with usual Western diets. Any reduction in breast cancer risk appears to be significantly dependent on the level of fibre intake. Several explanations can be proposed, including measurement errors in food intake, the insufficiency of food-composition tables, the difficulty of allowing for the diversity of fibre intake and the complexity of the natural history of breast cancer. More research is needed, not only better nutritional surveys for the different types of fibre intake and improvements in food-composition tables, but also epidemiological studies with the power to control for all the eventual confounding risk factors. Although the scientific evidence is not complete, recommendations for a fibre-rich diet should be made, both for cereals and for fruit and vegetables, in part because such diets at least do no harm, but also because fibre is known to be protective against other pathological conditions.
Publication Types:
Review
Review, Tutorial
PMID: 9696944 [PubMed - indexed for MEDLINE]
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Essential Oils as Components of a Diet-Based Approach to Management of Helicobacter Infection
Essential Oils as Components of a Diet-Based Approach to Management of Helicobacter Infection
G. E. Bergonzelli,* D. Donnicola, N. Porta, and I. E. Corthésy-Theulaz
Nestle Research Center, Lausanne, Switzerland
Received 30 December 2002/ Returned for modification 26 April 2003/ Accepted 7 July 2003
An increased density of Helicobacter pylori in the gastric mucosa can be associated with more severe gastritis and an increased incidence of peptic ulcers. Therefore, people with asymptomatic gastritis would certainly benefit from a nutritional approach to help them manage the infection and therefore decrease the risk of development of associated pathologies. We analyzed the activities of 60 essential oils against H. pylori P1 and identified 30 oils that affected growth, with in vitro inhibition zones ranging between 0.7 and 6.3 cm in diameter. We further analyzed the effects of 16 oils with different activities on H. pylori P1 viability. Fifteen showed strong bactericidal activities, with minimal bactericidal concentrations after 24 h ranging from 0.02 to 0.1 g/liter at pH 7.4. Even though slight variations in activities were observed, the essential oils that displayed the strongest bactericidal potentials against H. pylori P1 were also active against other Helicobacter strains tested. Among the pure constituents of different essential oils tested, carvacrol, isoeugenol, nerol, citral, and sabinene exhibited the strongest anti-H. pylori activities. Although oral treatment of H. pylori SS1-infected mice with carrot seed oil did not result in significant decreases in the bacterial loads in the treated animals compared to those in the control animals, in all experiments performed, the infection was cleared in 20 to 30% of carrot seed oil-treated animals. Our results indicate that essential oils are unlikely to be efficient anti-Helicobacter agents in vivo. However, their effects may not be irrelevant if one plans to use them as food additives to complement present therapies.
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* Corresponding author. Mailing address: Nestle Research Center, P.O. Box 4, CH-1000 Lausanne 26, Switzerland.
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Antimicrobial Agents and Chemotherapy, October 2003, p. 3240-3246, Vol. 47, No. 10
0066-4804/03/$08.00+0 DOI: 10.1128/AAC.47.10.3240-3246.2003
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