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Each year, the average person in the West consumes approximately
one metric tonne of food & drink and 6-7 lbs of chemicals. It is clearly
naive to suggest that these quantities of food can be irrelevant to human
health. Irritable Bowel Syndrome (IBS) consists of a cluster of symptoms
including nausea, indigestion, feeling bloated or windy, stomach pains,
constipation or diarrhoea, or both. For many years, the medical opinion
has attributed IBS to a lack of fibre or to stress; yet, since the sixties,
the amount of fibre in our diet (bread, cereals and pasta) has steadily
increased; the incidence of IBS has seen a similar increase in many western
countries. While stress is very common today, a large proportion of patients
strongly deny stressful circumstances in their lives to explain their IBS,
which raises some interesting questions about other causative mechanisms.
Variety of symptoms
Many patients are perplexed with their condition. It
does not often follow a pattern, some feel worse after meals, others experience
some good spells when their symptoms unexpectedly clear, only to reccur
a few days later; others suffer with additional problems, seemingly unrelated
to the intestine i.e. feeling tired, with low concentration and mood and
aching limbs or back aches. In spite of being so common, irritable bowel
remains a “phantom” condition in Medicine. The variety of
symptoms people experience can sometimes point to the upper part of the
digestive system or to the lower (colon) but frequently, people complain
of problems affecting both.
Investigations of the digestive system available in
specialist hospital units such as endoscopy, coloscopy or barium studies,
are often normal, thereby reinforcing the other popular belief that IBS
is a “stress-related” condition. But is it really “in
the mind”, just a simple “psychological” response?
Food allergies & Allergy Tests
 A
number of sufferers, mostly young or middle aged women, find that avoiding
certain common foods, clearly gives them relief of their symptoms. The
reason for this is that they have simple food reactivities – different
from the serious allergy to egg or peanut, these are lesser allergies
or intolerances. It is possible to identify the triggers of one’s
symptoms with a number of different methods:
a) some blood tests can pick-up reactive foods. Measuring
one’s levels of immunoglobulin-G or a “cellular” test
assessing the effect of various foods on the size of blood cells may help
to identify simple problems and have been supported by some medical research.
However, these tests offer results with variable accuracy and consistency.
 b) the Elimination &
Challenge Diet: by initially avoiding most common allergenic foods, if/when
symptoms clear within 7-14 days, the avoided foods are re-introduced one
by one to clarify which ones are causing the symptoms. Many overweight
patients are surprised to hear that this type of reactivity to foods is
also the most common cause of weight problems (the immune system, in its
effort to dilute the effect of some troublesome foods retains substantial
amounts of fluid).
c) intra-cutaneous (intra-dermal) tests are skin
tests which seem to offer more accurate results than ordinary skin prick
tests: a painless injection of a drop of diluted food is placed in the
dermis, the top layer of the skin - the resulting bleb increases in size
within 10 minutes, if there is a reaction to the item tested.
Abnormal intestinal fermentation
 A
second common problem is abnormal gut fermentation, which can be the result
of bacterial or yeast activity. Some blame Candida albicans for this,
a yeast micro-organism, the cause of vaginal thrush and the commonest
gynaecological infection in the West. In reality the issue is more complex,
yet easy to diagnose and treat. Specific tests can detect the presence
of raised levels of different alcohols, which are specific to bacterial
or fungal excess in the intestine.
Parasites
As many as 20% of people with an “unhappy”
gut, may have simple parasites. While most laboratories can identify common
infections like Campylobacter, Giardia or Salmonella, single cell parasites
including Blastocystis or Dientamoeba require a fixative to prevent their
disintegration outside the human body. Once identified, these too can
be eradicated with appropriate treatment – See section on parasites.
Other factors
Low production of hydrochloric acid (“hypochlorhydria”)
and low pancreatic enzymes may be important factors in understanding some
types of irritable bowel. The presence of naturally found or added chemicals
in food have also been associated with chronic digestive problems in medical
literature.
Is irritable bowel just “a nuisance”?
Whilst the majority of people with IBS seem to have
a few symptoms which cause them inconvenience rather than constant, serious
ill health, a minority suffer with symptoms severe enough to count as
a “disability”. Nutritional deficiencies are more common in
irritable bowel than healthy population; today, it is recognised that
cancer of the colon, sometimes is preceded by many years of intestinal
symptoms, with changes of the intestinal mucosa, which can only be detected
microscopically and sometimes elude specialist investigations. Some research
suggests there is a risk that irritable bowel can precede colonic cancer
by some decades, by causing low grade inflammation.
Case histories
Case 1: AW a 26 year old
female teacher from Bradford, had nausea, stomach pains and loose bowel
since she suffered with acute gastroenteritis while on holiday in the
Carribean, 3 years ago. She was investigated with stool culture and colonoscopy,
which were normal and skin prick tests ruled out any food allergies. However,
further testing showed that she had protozoan parasites, which were eradicated
after two short courses of appropriate antibiotics. Her residual symptoms
cleared 8 days after she started avoiding some common foods. During re-introduction
she identified reactivities to corn, wheat, yeast and chicken, which she
avoided for a further 2 months, when her tolerance improved and she was
able to eat them sporadically.
Case 2: GN a 25 year old
IT technician with an eleven year history of Crohn’s disease and
two operations, in which part of the bowel was removed, was suffering
with intermittent lower abdominal pain, diarrhoea and bloating; His specialist
confirmed that the remaining intestine was fine. He was found to have
raised blood ethanol levels (consistent with fungal overgrowth), extensive
nutritional deficiencies and intra-dermal tests showed several reactive
foods, too many to safely avoid. He was treated with a course of antifungals
and was recommended to take a number of nutritional supplements long-term.
He required treatment with a low-dose desensitisation, to improve his
immunity to most foods which were causing him problems. His symptoms cleared
after two treatments and he continues a maintenance course with two treatments
a year.
Summary
In an era, when we no longer “eat to live”,
when fast life-styles favour fast, readily available food and when diets
have become quite repetitive, is there a “quick-fix” for this
problem? The consensus amongst many doctors, who share a special interest
in a cause-oriented management of irritable bowel, is that there isn’t
one. However, more-often-than-not what is possible is to identify the
main “culprits” and modify one’s diet to safer foods.
Many patients are surprised with the choice of safer foods available today
and seem delighted if their symptoms clear in the process. The effect
of changing one’s diet often has some unexpected benefits on health,
although, as with every habit, it is sometimes hard to break.
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