Irritable Bowel and other digestive conditions

Fibre not always beneficial

We don’t need to look far before seeing advertising to eat more fibre advocated as beneficial to our digestive health.  Over the past 10 years I have noticed that more patients’ digestive issues actually improve by removing too much fibre from their diet.  A novel idea?  I think not.  Much research has gone into the many and varied conditions afflicting our digestive tract.  There is no “one size fits all” remedy as we are all different.  Some aspects of one dietary plan may work but not all the time.  That is where it is important to seek a personalised health assessment before embarking on a plan that you read about on the internet.

Dr Natasha Campbell-McBride uses the GAPS or Gut and Psychology Syndrome Nutritional Program which is a structured diet followed in varying steps until the gut has recovered.  The fundamental treatment for most digestive issues includes repairing a leaky gut; removing irritant foods/substances; replacing beneficial bacteria and detoxifying the body.  This can be done using a variety of supportive and dietary techniques, but any treatment will only succeed if the ‘offending’ substances are removed. 

The link between the gut and the brain has now been scientifically verified.  Conditions involved include Autism, ADHD, delayed development in children and behavioural issues as well as autoimmune and inflammatory conditions including: 

Multiple Sclerosis, Lupus, Crohn’s Disease, Fibromyalgia, Chronic Fatigue Syndrome, Rheumatoid & Osteoarthritis, Allergis and Atopic conditions as well as depression and obsessive compulsive disorders.

“In terms of Gut and Psychology Syndrome, we are talking about the functioning of the brain of the person,” Dr. McBride explains. “Any dysfunction of the brain is usually connected to what’s going on in the digestive system. In Gut and Physiology Syndrome, we’re talking about the functioning of the rest of the body. Hippocrates… made a statement that all diseases begin in the gut. The more we learn now with all our modern scientific tools, the more we realize just how correct he was.”

Gluten Sensitivity Without Coeliac Disease?

It is always refreshing to read about research which substantiates what I find in clinic. During live blood screenings I frequently note gluten irritation to the bowels in non-coeliac patients. The following article supports the fact that gluten intolerance does exist outside of genetic coeliac disease.

A gluten-free diet might benefit selected patients with irritable bowel syndrome.Some patients with symptoms of irritable bowel syndrome (IBS), but no evidence of celiac disease, report gluten sensitivity. To determine whether these observations hold up under double-blind, placebo-controlled conditions, Australian researchers enrolled 34 adults in whom celiac disease had been ruled out by standard criteria but who reported intolerance to gluten-containing products.

They all followed their typical gluten-free diets and, additionally, were randomised to receive either gluten-containing or gluten-free (placebo) bread and muffins daily for 6 weeks. The proportion of patients who reported inadequate control of overall symptoms was significantly higher in the gluten group than in the placebo group (68% vs. 40%). Several specific symptoms (abdominal pain, tiredness, dissatisfaction with stool consistency, and bloating) also were significantly more prominent in the gluten group. No differences in markers of inflammation in blood or stool were noted between groups.

Comment: This study suggests that gluten can trigger irritable bowel symptoms –– via unknown mechanisms –– in some people who exhibit no evidence of celiac disease. A therapeutic trial of a gluten-free diet might be worthwhile for selected patients with IBS.

Source:  Biesiekierski JR et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: A double-blind randomised placebo-controlled trial. Am J Gastroenterol 2011 Mar; 106:508. (http://dx.doi.org/10.1038/ajg.2010.487 

The emphasis on grains in the Western Diet for the past five decades or so has left many with a pain in the gut.  Please read Dr Mercola’s report on the effect of grains on our digestive tract, especially the development of leaky gut syndrome.  I see an increasing incidence of leaky gut in my clinic.  Changes in diet have turned many people’s lives around – healing the gut issues that resulted from poor choices.

A sweet intolerance

Fructose malabsorption is believed to be an underestimated cause of symptoms for many who suffer from irritable bowel syndrome (IBS).

The culprit, fructose, can exist in many foods and beverages, not only in fruit.

Recognising fructose malabsorption

During my time in clinic, most people who present with IBS respond well to traditional digestive treatments.  However, there has been an increasing frequency of those presenting with unexplained IBS.  

How does fructose intolerance cause symptoms? 

The body’s inability to absorb fructose in the small intestine leads to a build-up of fructose in the digestive tract.  Unabsorbed fructose travels to the bowel where it causes numerous side effects.  As fructose provides an excellent basis for microbial fermentation, it produces gases which cause flatulence and bloating.  Other effects include osmotic diarrhoea, abdominal pain and distension.    If left untreated, the imbalance in good microbes further influences gut motility and contributes to inflammation and increased permeability of the gastrointestinal wall.  Reflux is also linked to fructose malabsorption in many patients.

So, how do you know if your symptoms are due to fructose malabsorption?  A process of elimination may identify the underlying cause for your symptoms. 

Symptom resolution achieved by removing high fructose foods from your diet is highly suggestive of fructose malabsorption.  Confirmation can be obtained through the breath hydrogen test (BHT) which can be prescribed by your GP.

Managing fructose malabsorption and its symptoms

A low fructose diet remains the most effective method of symptom management.    Complete avoidance of fructose is not necessary as small doses are still well tolerated.  However, fructose consumption should be limited to less than 25g daily. 

Glucose improves fructose uptake.  Therefore, foods that contain more glucose than fructose are generally well tolerated, e.g. ripe bananas.  Due to glucose’s ability to assist in the uptake of fructose, glucose powder added to fruit juices or high-fructose foods whilst cooking, may improve fructose absorption.  However, this is only recommended occasionally.

Sorbitol should be restricted to less than 5g daily as this reduces fructose uptake and worsens symptoms by contributing to osmotic diarrhoea.

High concentrations of fructans often pose a problem.  Fructans are present in many wheat products, which may explain why many IBS sufferers respond well to a wheat-free diet. 

Moods and fructose malabsorption

Research has demonstrated that a fructose and sorbitol reduced diet in those with fructose malabsorption not only reduces gastrointestinal symptoms but also improves mood and early signs of depression.  Further investigations identified that fructose malabsorption is associated with lower tryptophan levels which may play a role in the development of depressive disorders.  High intestinal fructose concentration seems to interfere with tryptophan metabolism, reducing its availability for serotonin synthesis. 

Should you be experiencing concurrent mood disorders and IBS symptoms, fructose malabsorption may need to be considered. 

Restoring a healthy digestion

The inflammation caused by IBS has been linked to increased levels of infection, obesity and hypertension.  Natural methods of regulating inflammation include high EPA fish oils and probiotics.

Dysbiosis and local inflammation compromise digestion by reducing your body’s ability to absorb nutrients.  In addition to quality fish oils and probiotics, digestive enzymes may assist in absorption and restoration of a healthy gastrointestinal tract.

Why the sudden increase in fructose intolerance?

As with most health conditions, fructose intolerance is an example of too much for too long.  As described above, fructose is not only found in fruits.  High fructose corn syrup (HFCS) has been used as the main ingredient in soft drinks, juices, cereals and many other foods traditionally consumed by Western societies.  Increased and excess consumption, particularly by children, in addition to wheat-based foods, is, I feel, the main contributor to the increase in fructose intolerance in our society.

Does this mean that fruit is bad for us?  I do not believe so.  However, if your diet is high in soft drinks, processed foods and wheat-based products, a piece of fruit may just tip your body into inflammation.  It would be more beneficial to avoid the processed foods and consume up to 25g of fructose from fresh fruit.

Fruit is best consumed whole rather than juiced as juices are highly concentrated in fructose.  Should you wish to drink fruit juice, juice your own rather than buy processed varieties. 

Apart from causing intestinal irritation, excess fructose may also be linked to the increase in fatty-liver disease.  Dr Mercola writes more about these aspects of fructose on his website.

Foods to avoid

High fructose High sorbitol High fructans
  • Fruit juices
  • Dried fruit
  • Foods containing apple or pear concentrate
  • Honey
  • Apple
  • Pear
  • Watermelon
  • Mango
  • Food sweetened with high fructose corn syrup
  • Sauces:  BBQ, sweet & sour, plum sauce
  • Chutney
  • Sugar-free chewing gum
  • Sugar-free lollies
  • Prunes
  • Stone fruits (large quantities)
  • Onion
  • Leek
  • Asparagus
  • Jerusalem artichoke
  • Large quantities of wheat products (bread, pasta, pastry, cereals)