How Diet Affects IBS: Tips for Better Digestive Health

Posted on October 9, 2023December 27, 2024 by fuelmarketing

Irritable Bowel Syndrome (IBS) is a common digestive disorder affecting millions of people worldwide. Characterized by symptoms like abdominal pain, bloating, diarrhea, and constipation, IBS can significantly impact quality of life. One effective way to manage these symptoms is through dietary changes. We will delve into how diet influences IBS and provide actionable tips for better digestive health.

The Role of Diet in IBS

Trigger Foods

For many individuals with IBS, foods rich in fats, dairy, and certain types of carbohydrates—known as FODMAPs—can lead to symptoms. Other triggers might include spicy foods, alcohol, and caffeinated beverages. Identifying and eliminating these triggers can significantly improve IBS symptoms.

Foods to Include

A balanced diet for someone with IBS might include lean proteins, low-FODMAP fruits and vegetables, and whole grains. Incorporating foods rich in soluble fiber can also be beneficial in regulating bowel movements.

IBS-Friendly Diet Plans

Several diet plans are specifically tailored for individuals with IBS. These plans generally focus on low-FODMAP foods and include soluble fiber to aid in digestion.

The Low-FODMAP Diet

This diet restricts various types of carbohydrates that are difficult to digest and likely to ferment in the gut, causing gas and discomfort. The elimination phase removes high-FODMAP foods for a few weeks. Reintroduction occurs gradually to gauge tolerance levels.

The Mediterranean Diet

Although not designed for IBS, the Mediterranean diet is often well-tolerated. It emphasizes fruits, vegetables, lean proteins, and healthy fats, while limiting processed foods and sugars that might aggravate IBS symptoms.

Dietary Supplements and Probiotics

Some people find relief from IBS symptoms by incorporating dietary supplements and probiotics into their routine. Fiber supplements can help regulate bowel movements, while probiotics can balance gut flora. However, it’s crucial to consult a healthcare provider for personalized advice, as these supplements can also potentially worsen symptoms in some cases.

Monitoring and Adjustment

Managing IBS through diet can be a process of trial and error. It’s advisable to maintain a food diary to note which foods trigger symptoms and which offer relief. Over time, this can help tailor a dietary plan that minimizes discomfort and improves digestive health.

Dietary changes can have a profound effect on IBS symptoms. By identifying trigger foods and incorporating IBS-friendly diet plans and supplements, individuals can take significant steps toward better digestive health.

Struggling with IBS?

Are you struggling with IBS and need guidance from a medical expert? Reach out to us for a personalized consultation that can set you on the path toward better digestive health.

The Role of Endoscopy in Gastrointestinal Health

Posted on September 11, 2023December 27, 2024 by fuelmarketing

Gastrointestinal issues are not only uncomfortable but may also indicate more serious underlying conditions. One of the key diagnostic tools in the field of gastroenterology is endoscopy. This procedure allows healthcare providers to visualize inside the gastrointestinal tract, aiding in the diagnosis and treatment of various conditions. But what exactly is endoscopy, and how does it contribute to gastrointestinal health?

What Is Endoscopy?

Endoscopy is a medical procedure using a specialized instrument known as an endoscope. This device is a flexible, lighted tube with a miniature camera that allows doctors to view the interior lining of the digestive tract. An endoscope can be inserted through either the mouth or the anus, depending on which part of the gastrointestinal tract needs to be examined.

Types of Endoscopy

Three types of endoscopic procedures we use at Granite Peaks are:

Upper Endoscopy

This procedure examines the upper part of the digestive system, including the esophagus, stomach, and the first part of the small intestine. It is commonly performed to diagnose conditions like acid reflux, ulcers, and certain types of tumors.

Colonoscopy

A specialized form of endoscopy, colonoscopy is designed to examine the rectum, colon and cecum, where the small and large intestines meet. It is particularly useful for early detection of colorectal cancer and immediate removal of colon polyps. It also is used to diagnose inflammatory bowel diseases like Crohn’s and ulcerative colitis, and to investigate the cause of diarrhea, bleeding, anemia and many other conditions.

Capsule Endoscopy

Capsule endoscopy is most helpful for diagnosing conditions in the small intestine. This long, winding organ cannot be visualized with an ordinary endoscope. The patient swallows a small capsule with a camera inside. As the capsule travels through the digestive system, it records pictures of the inside of the intestine, providing valuable information for the gastroenterologist.

Benefits of Endoscopy

Accurate Diagnosis

The direct visualization of the gastrointestinal tract allows for a more accurate diagnosis than other imaging tests like X-rays and allows for biopsies to be taken to test for disease cells.

Minimally Invasive

Being less invasive compared to surgery, an endoscopy procedure poses fewer risks, and recovery is quick – just a few hours to recover from anesthesia.

Therapeutic Applications

Beyond diagnosis, endoscopy can also be used for treatment purposes. For instance, doctors can remove polyps during a colonoscopy or stop bleeding in the gastrointestinal tract.

Risks and Considerations

Although endoscopy is generally considered safe, there are risks as with any medical procedure, such as infection, bleeding, or perforation of the gastrointestinal tract. Always discuss with your gastroenterologist whether endoscopy is the most appropriate diagnostic tool for your specific condition.

When Should You Consider an Endoscopy?

If you are experiencing symptoms like persistent abdominal pain, unexplained weight loss, or difficulty swallowing, your healthcare provider may recommend an endoscopic examination. Likewise, routine screenings like colonoscopies are recommended for individuals over the age of 45 as a preventative measure against colorectal cancer.

Endoscopy procedures play a vital role in the diagnosis and treatment of gastrointestinal issues. The minimally invasive nature, coupled with the diagnostic and therapeutic capabilities, makes endoscopy an invaluable tool in modern gastroenterology. If you are facing persistent gastrointestinal issues, consult your gastroenterology specialist to determine if endoscopy could be an appropriate step toward effectively managing your condition.

If you’re experiencing persistent gastrointestinal issues or are due for a routine screening, take control of your health today. Contact our specialized team to schedule an office visit or an endoscopy procedure and get the comprehensive care you deserve.

What To Do When You Experience Bloating

Posted on March 16, 2023December 27, 2024 by fuelmarketing

We all suffer from that uncomfortable bloated feeling, on occasion. Bloating is an all-too-common digestive issue that can be caused by a number of things, including serious conditions or medications. Sometimes it’s as simple as overeating or eating too quickly that can cause your stomach to act up. But don’t worry—there are easy solutions! Here we’ll share three simple tips for reducing bloating: eat slower, keep good posture while eating, and take a walk afterwards. Making these small changes in your day can help improve your digestion and make your bloat vanish before you know it!

Eat Slower

The first thing to help prevent bloating from ever starting is to eat slowly. Eating too quickly can cause you to swallow more air with your food, leading to bloat and discomfort. Take time to thoroughly chew your food to break down the food particles, making them easier to digest. To eat slower, try putting your utensils down between bites, taking small sips of water, and engaging in conversation with others at the table.

Sit Up Straighter

Your mother was on to something here! When your stomach feels bloated try sitting up straight while eating. Not sitting upright while you eat can impede the digestive process and lead to bloating. With improved posture, your digestive system will function better and avoid uncomfortable gas build up. This is also a great way to enhance your core strength and overall spinal health by reducing strain on the back muscles. So remember: when it’s mealtime – sit up straight to beat the bloat!

Take a Walk

Stroll away your digestive discomfort by taking a walk after eating. Walking helps to get things moving in your digestive system, aiding your food’s journey through your gut, and diminishing trapped air that can lead to bloating. Plus, it keeps you healthy – raising physical activity levels; lowering stress; and enhancing mood!

Bloating can be unpleasant and distressing. Try these easy tips to reduce or manage it. If your bloating persists or is accompanied by other symptoms, such as abdominal pain or diarrhea, it may be a sign of an underlying medical condition, and you should consult with your healthcare provider to determine the cause an appropriate treatment.

Be sure to look out for these other signs that it’s time to visit your gastroenterologist!

Thinking You May Have Crohn’s? Maybe Not.

Posted on December 14, 2022December 27, 2024 by fuelmarketing

Having painful digestive symptoms can be difficult to explain to a doctor and hard to pinpoint. Sometimes symptoms may flare up when you eat certain foods or experience high-stress levels or may randomly happen. Crohn’s disease is characterized by long-term digestive tract inflammation which may cause belly pain, diarrhea, bleeding, tiredness, and weight loss. The tricky thing about Crohn’s disease is that those symptoms are very similar to other digestive conditions, so much so that there are some conditions that you may mistake for Crohn’s disease. Your gastroenterologist is the right person to do appropriate tests and identify whether it’s Crohn’s or something else.

Celiac Disease

Those who have celiac disease are unable to digest gluten. Instead of being digested, gluten damages and eventually destroys the intestinal villi. Over time, this prevents nutrient absorption and causes growth and additional physical ailments. Professional diagnosis is important since those with celiac disease may experience weight loss, diarrhea, and tiredness and those with Crohn’s disease may also have trouble with gluten.

Food Intolerances or Allergies

Your digestive system normally does a good job breaking down and absorbing food. If it doesn’t work with certain foods, you may have a food intolerance. Similarly, your body’s immune system is designed to protect you against foreign invaders and dangerous substances, but it may overreact to harmless foods. When this happens, it’s called a food allergy. Both intolerances and allergies have symptoms similar to Crohn’s such as belly pain and cramps, diarrhea, and nausea.

Diverticulitis

As you age, your intestines develop small bulging pouches, primarily in the colon, called diverticula. They’re mostly harmless until they become inflamed or infected. When that happens, it’s known as diverticulitis. Symptoms include lower gut pain that lasts a few days, nausea, vomiting, diarrhea, and fever, all of which are also symptoms associated with Crohn’s disease.

Don’t Self-Diagnose

All the conditions mentioned here require medical diagnosis and intervention to prevent further damage to your digestive system. See your Granite Peaks gastroenterologist to get a professional diagnosis and care plan to manage your digestive health. Correctly identifying the issue is key to getting the care you need.

For this reason, make an appointment to see a gastroenterologist sooner rather than later so you know the issue and how to address it.

Learn more about Crohn’s disease and other conditions with which the gastroenterologists at Granite Peaks Gastroenterology can help! Start here to learn about Crohn’s!

Belching, Bloating, and Flatulence

Posted on June 9, 2022December 27, 2024 by May Marschner

We know it’s embarrassing when your digestive symptoms become noticeable to others. There can be many causes for the belching, bloating and flatulence that you may experience and your gastroenterologist can help you find the culprit that is interrupting your life. Read on to learn more.

Jump To:

Symptoms and Possible Causes

Conditions That May Cause Symptoms

Diagnosing Your Symptoms

Option to Rule Out Dietary Influences

Originally posted on 4/10/2018
Updated on 6/9/2022

Belching, bloating, and flatulence: Any of these symptoms can be embarrassing, leading to unwanted noises, abdominal discomfort, and general malaise. Occasionally experiencing these symptoms is normal, but if symptoms become excessive or too frequent, they can negatively impact your life.

Symptoms and Possible Causes

Belching occurs when excess air is swallowed, causing the stomach to become too full. Flatulence may be a result of this swallowed air, or it can be caused by gas produced by bacteria in the colon. Bloating is a feeling of fullness in the upper abdomen that may be caused by gas in the stomach or intestines.

Issues that can lead to swallowing excess air:
• Simply eating food
• Chewing gum
• Carbonated beverages
• Experiencing anxiety
• Poorly-fitting dentures
• Postnasal drip

Excess intestinal gas can be caused by:
• Gas-producing foods such as cabbage, cauliflower, broccoli, and beans
• Bran and other high-fiber cereals
• Dairy products including milk, some cheeses, and ice cream – especially those dairy products that lack the enzyme lactase, which is necessary to digest milk sugars
• Bacterial overgrowth – normal bacteria in the gut that produce intestinal gas

Carbohydrates that are not digested well in the small intestine travel to the colon where they are metabolized by bacteria into hydrogen and carbon dioxide gases. This causes cramping, bloating, and flatulence. In some people, these gases can accumulate in the right upper section of the colon, leading to pain similar to gallbladder pain. Gas accumulated in the left upper section of the colon can cause chest pain that feels like a cardiac episode.

Conditions That May Cause These Symptoms

• Those suffering from Irritable Bowel Syndrome (IBS) can be extremely sensitive to increased intestinal gases.
• Patients with altered anatomy from surgical changes or with poor intestinal motility can be at increased risk of bacterial overgrowth, leading to excess gas.
• If postnasal drip is suspected, your doctor may check for sinus problems.

Diagnosing for Belching, Bloating and Flatulence:

Our Granite Peaks Gastroenterology Specialists will meet with you to discuss your symptoms and determine what tests may be needed. They may recommend an upper endoscopy, depending on the frequency, severity, and location of your symptoms. If celiac disease is suspected, this may be detected during an upper endoscopy. If bacterial overgrowth is a possibility, it may be diagnosed with a breath test.

Some Options to Rule Out Dietary Influences:

• Withdraw dairy products from the diet to rule out lactose intolerance
• Eliminate carbonated beverages from the diet
• Eliminate gas-producing foods such as cauliflower, cabbage, broccoli, beans, and bran from the diet—eliminate these ones by one and keep a diary of symptoms
• Avoid sugar-free gum and hard candies—the sweeteners can cause extra gas while chewing gum and sucking on candy cause one to swallow excess air.

Remember that everyone experiences belching, bloating, and flatulence at one time or another. It’s normal! However, if it is interrupting your life, causing you frequent, recurring discomfort; or causing you to feel generally unwell, it is time to seek professional help.

Granite Peaks Gastroenterology Specialists are available to help you find answers and stop these uncomfortable and embarrassing symptoms. Call us today at (801) 619-9000 to make an appointment.

What is Lactose Intolerance?

Posted on June 15, 2021December 27, 2024 by Granite Peaks

What is Lactose Intolerance?

If your body does not produce a sufficient level of lactase, the digestive enzyme needed to break down lactose, you may suffer symptoms of lactose intolerance. Your body does not make enough lactase to break down the sugar in milk products. The lactose is not digested in the small intestine, so it moves into the colon, undigested, which then causes uncomfortable symptoms.
This condition may be more common in adults. As we age, some of us naturally produce less lactase. Some ethnic groups are more prone to have low-to-no lactase production. Individuals who may have other digestive conditions such as Crohn’s disease, celiac disease, or infection may also show symptoms of lactose intolerance.

Symptoms of Lactose Intolerance

The good news is that lactose intolerance does not harm your intestines, but its uncomfortable symptoms are anything but good. Depending on the type and amount of lactose consumed, you may experience some of these symptoms:

Painful gas
Bloating
Diarrhea
Abdominal pain and cramping
Nausea or vomiting

4 Ways Lactose Intolerance Symptoms May Be Managed

Getting an accurate diagnosis of your condition is important. Often, individuals are not only lactose-intolerant but suffer with additional enzyme deficiencies. Testing for these deficiencies (disaccharidase deficiencies) may be necessary for accurate diagnosis and treatment. Seeing a gastroenterology specialist will ensure you are treating the right ailment and are implementing a complete and nutritionally adequate treatment plan for your condition.

Once a diagnosis is made, individuals with lactose intolerance may be able to control most symptoms with dietary changes.

1. Reduce Dairy

If your healthcare provider feels it’s appropriate, they might suggest eating smaller amounts of lactose-containing foods to determine whether smaller amounts may be well-tolerated.

2. Eliminate Dairy

If reducing lactose-containing foods does not work, a few common foods for those suffering from lactose intolerance to avoid are:

Milk
Ice Cream
Cheese
Sour Cream
Curds
Butter

*Watch for hidden sources of lactose including coffee creamers, bread and cereal, creamy salad dressings, pre-packaged mixes for making cookies, cake, or pancakes. There are brands now available that are safe for those who are lactose intolerant.

Continuing on a dairy-free diet may mean a lack of certain vitamins and minerals needed for adequate nutrition. Your gastroenterologist will provide a plan for you to get enough vitamin D, calcium and other minerals from your diet when you eliminate lactose-containing foods.

3. Use an Over-the-Counter Enzyme Supplement

For those who are significantly affected by even small amounts of lactose, over the counter medications such as Lactaid®, or generic versions of a lactase supplement may help. This medication is taken with or prior to eating lactose-containing food to ease and eliminate symptoms.

4. Lactose-Free Foods

Grocery stores have begun to regularly carry all sorts of food options for those with food allergies or specific eating styles. Affordable, lactose-free options are available in milk, cheese, and other dairy products. Lactose-free pre-packaged mixes and foods are also easy to fin. Watch the dairy-free label on the package.

Protect Your Calcium and Vitamin D Levels

If you are lactose intolerant, you may need to be more deliberate about your nutrition to maintain your calcium and vitamin D levels. Good food sources of calcium and vitamin D are:

Green leafy vegetables
Broccoli
Oranges
Dried Figs
Products made using fortified flour – such as bread and cereals
Dried peas and beans
Calcium fortified juices
Almonds, Brazil nuts
Soy, oat, almond or rice milk

Check with your Granite Peaks gastroenterology specialist if you are considering supplements to support your calcium and vitamin levels to be sure you are taking an appropriate amount for your age and your good health. As with any health condition, don’t go it alone! Talk to a specialist who can help you feel your best while addressing your specific health issues.

The Facts About Constipation and How to Treat It

Posted on August 22, 2018December 27, 2024 by James Stewart

by James M Stewart, MD

The gastrointestinal tract is designed to break apart food so that we absorb the nutrients we need while leaving behind the material in food we don’t need. To do this, our body secretes digestive enzymes from the pancreas and water from the body to liquefy the food we eat so that it can mix around in the intestines. Once the nutrients are absorbed, the remaining liquid with the non-absorbed food material enters the large intestine.

The role of the large intestine is to remove as much of the remaining liquid that was added to the food so that we don’t waste water. It is a very slow process and usually takes about 24 hours. Through very slow movements, the liquid waste is slowly turned into solid waste until enough has accumulated. At this point, most of us will feel the need to have a bowel movement and push the solid waste out of the body.

Constipation is when that process takes too long or there is something not functioning correctly with the muscles that coordinate bowel movements. When one meets with a physician, it is important to be very clear what one means by constipation because there are multiple symptoms that are called constipation. Constipation can mean that you have very infrequent bowel movements (less than 3 per week) or that it can very difficult to pass stool (straining while having a bowel movement). For the purposes of this article we will discuss infrequent bowel movements.

Most constipation in the United States is related to slow movement through the large intestine which results in infrequent bowel movements or hard bowel movements. There are many things that slow down the movement through the large intestine and most of them are harmless and do not impact one’s health but can affect one’s wellbeing. Pain medications containing opiates are one of the most common causes of drug-induced constipation. Stress, anxiety, and depression can also alter the function of the large intestine causing things to slow down. Certain diets, particularly those that are low in fiber, can cause temporary constipation. In some cases, the large intestine just doesn’t move as quickly as we would like.

Discussing symptoms with a physician can usually uncover some of the causes of constipation. Blood testing can sometimes help. Colonoscopy can sometimes be useful if there is any suspicion for narrowing in the intestines causing a blockage which can sometimes occur with colon cancer or large polyps.

Once the dangerous causes of constipation have been ruled out, treatment for constipation usually consists of increasing physical activity, dietary changes to increase fiber, using fiber supplements, and sometimes medications. Light to moderate exercise has been shown in multiple studies to help stimulate bowel function to have more regular bowel movements. Fiber supplements like psyllium husk (Metamucil) contains natural fibers which are non-digestible plant products. Other fibers include bran as well as semi-synthetic fibers such as Benefiber and Citracel.

Medications, or laxatives, can be divided into four categories.

• Osmotic laxatives, such as Miralax and lactulose, function much like fiber and help hold more water in the large intestines. These are extraordinarily safe medications because they do not alter any chemical receptors or nerves in the body but just change the osmotic gradient in the large intestine. These medications are not absorbed into the body and are eliminated with a bowel movement.

• Stimulant laxatives, such as Senna or bisacodyl, stimulate the large intestine to have a bowel movement. These medications are available over the counter and are safe for short-term and long-term use. Older versions of these medications were found to be unsafe and were removed from the market many decades ago, but the current medications are safe for long-term use.

• Secretory laxatives, such as Linzess, Amitiza, and Trulance, encourage the body to secrete more fluid into the small intestine to act as a “flush” and push the bowel movement out. These are available as a prescription and are very well tolerated and safe for long-term use.

• Opiate blockers, such as Relistor and Movantik, are only indicated for those using opiate containing pain medications. These medications will block the opiate effect in the intestines while still allowing the anti-pain effect of the opiates.

In summary, most constipation in the United States is caused by a variety of things that can slow down the large intestines. Discussing these symptoms with a gastrointestinal expert can help identify some of the causes of constipation and find ways to reverse them. Also, some constipation can be caused by serious conditions such as colon cancer so further testing may be required. Once the causes of have been identified, there are many safe and sensible therapies to treat constipation and improve one’s quality of life.

C. Difficile Infection

Posted on February 28, 2018December 27, 2024 by May Marschner

Antibiotics are effective medications commonly used to treat infection. Although safe, they can cause side effects, including diarrhea, in up to 20% of patients, usually improving when the antibiotics are stopped. In some patients Clostridium difficile infection (CDI) can develop due to a toxin-producing bacteria that causes a severe form of diarrhea associated with antibiotic use. Symptoms can range from mild diarrhea to severe colon inflammation that can be fatal.

With increased antibiotic use in the U.S., Canada and other countries, the number of CDI cases has dramatically increased. C. difficile spores are very common in the environment and difficult to get rid of. They produce two main toxins that cause inflammation in the colon.

Although most cases of CDI are antibiotic-related, there are additional risk factors that do not include antibiotic use such as older age, weakened immune system, being in a hospital or long-term care facility. Those with inflammatory bowel disease are more likely to get CDI and may face a more intense illness than patients with IBD or CDI alone. Acid-suppressing medicines may also increase the risk of contracting CDI.

Patients experience diarrhea, the most common symptom, and may experience abdominal cramping associated with the watery stool. Vomiting, fever, nausea and generally feeling unwell can accompany the diarrhea. Severe cases include fever and abdominal distension.

A stool test is necessary to verify the presence of toxin in the stools and determine appropriate treatment. In mild cases, an antibiotic such as metronidazole may be used. If that isn’t effective, vancomycin is the next step and is usually effective.

While antibiotic treatment is effective in most cases of CDI, up to 20% of patients could experience recurrent symptoms and recurrence statistics rise from there (up to 60%) if the patient is not responding to a second round of antibiotic therapy.

For these patients, the most effective method for treating CDI is known as a fecal microbiota transplant, which has been effective in more than 90% of patients receiving the treatment in randomized controlled trials. The doctors at Granite Peaks Gastroenterology have experience and have had success with this treatment in multiple patients suffering from CDI who were unresponsive to traditional antibiotic treatment.

Don’t let symptoms go unattended. Check in with your doctor if you have symptoms of CDI, especially if you’ve recently used antibiotics. The sooner it is treated, the more likely it is that you’ll have a quick and complete recovery.

Abdominal Pain

Posted on February 6, 2018December 27, 2024 by James Stewart

by James M. Stewart, MD

Abdominal pain is one of the most common complaints a gastroenterologist hears in daily practice. Evaluating abdominal pain is complicated and often involves looking for patterns. The first place to start is with some questions about the pain.

Common questions include:

• When did the pain start? Whether a patient’s pain has been present acutely (starting within the last month) or chronically (starting months to years ago) helps narrow the diagnosis.

• Where does it hurt? Some abdominal pain stays in one part of the abdomen, such as just above the right hipbone (appendicitis) or under the right ribs (gallbladder disease). Other pains may migrate around the abdomen or be very difficult to localize to one spot.

• Does it ever go away? Most pains will come and go but some pains are consistent for long periods of time.

• Is there anything that a patient can do to make the pain better or worse? Is it associated with eating or defecating? Is it worse during the morning or night? Is it exercise or position-related?

• Are there any other symptoms present at the same time as the pain, such as diarrhea or nausea? This can help a physician figure out which part of the gastrointestinal tract is involved.

A physician’s physical exam focuses on palpating places in the abdomen to feel for masses or lumps that may provide clues. The physician is also trying to see if pressure will increase the pain. At the physician’s discretion, further physical exam aids include tapping on the abdomen to listen for trapped air or listening to the bowel sounds within the abdomen.

Bloodwork may be ordered to evaluate for abdominal pain. The physician will often combine physical exam, bloodwork, and the patient’s history with other diagnostic testing to find the cause or to suggest a treatment regimen.

If the physician believes that the pain is coming from the intestinal tract they may use an endoscopy to diagnose abdominal pain. An upper endoscopy is an evaluation through the mouth that looks at the esophagus, stomach, and the first several inches of the small intestine (the duodenum). A lower endoscopy, or colonoscopy, primarily evaluates the large intestine and a little of the very end of the small intestines. Biopsies can be taken during an endoscopy, which can be analyzed under a microscope to provide guidance regarding the pain.

Additional tests include 3D imaging of the abdomen, often done with a CT scan or with an ultrasound or MRI machine. These exams look under the skin and muscles of the abdomen to the organs underneath and see if anything looks unusual about them.

Sometimes, even after all of this testing, there is no obvious source of the abdominal pain. It can be frustrating for patients to not have a definitive cause for the pain.

At this point, a physician and patient discuss the pros and cons of medication, supplement trials or dietary approaches to aid the body. Sometimes, psychotherapy can be helpful if stress or anxiety are manifesting as abdominal pain. It takes patience and sometimes trial and error to find something that helps alleviate the pain. Since opiate-based pain medications can worsen gastrointestinal symptoms and pain, gastroenterologists very rarely use these medications.

Determining the cause of your abdominal pain can be a process, but one well worth discussing with your gastroenterologist to alleviate pain, discomfort and its interruptions to living your life well.

Are you Lactose Intolerant?

Posted on January 25, 2018December 27, 2024 by

OVERVIEW
Lactose is the sugar found in milk and dairy products such as cheese and yogurt. After eating dairy products that contain this sugar, usually lactase, a digestive enzyme of the small intestine, helps to breakdown this complex sugar into two simple sugars, glucose and galactose. These simple sugars are then absorbed in the small intestine and ultimately reach the blood stream where they act as nutrients. The enzyme lactase is located in the lining of the small intestine known as the intestinal villi.

In addition to milk and dairy products such as ice cream, yogurt and cheese, lactose can be found in bread and baked goods, processed breakfast cereals, instant potatoes, some soups and non-kosher lunch meats, candies, dressings and mixes for pancakes and biscuits. Lactose is also the sugar found in breast milk and standard infant formulas. Therefore almost all babies are able to digest and absorb this sugar and it serves as their primary dietary sugar.

SYMPTOMS
Because lactose is not digested properly in the small intestine of individuals who are lactose intolerant, it passes whole into the large intestine or colon. Upon reaching the colon it is broken down by the normal colon bacteria. This breakdown results in the production of carbon dioxide and hydrogen gases. The gas production can lead to the following common symptoms:

• Abdominal distension and pain
• Excess burping
• Loud bowel sounds
• Excess gas and diarrhea following ingestion of lactose.
• Watery and explosive bowel movements
• Urgency with bowel movements, which means that children feel that they have to get to the bathroom immediately or they will have an accident.

The symptoms of lactose intolerance can start during childhood or adolescence and tend to get worse with age. The severity of symptoms is usually proportional to the amount of the milk sugar ingested with more symptoms following a meal with higher milk sugar content.

Although eating lactose-containing products will result in discomfort for someone who is lactose intolerant, they are not at risk of developing more serious intestinal disease because of long-term lactose malabsorption. The only exception to this would be for babies who are born with primary lactase deficiency or children with secondary lactase deficiency as discussed below.

CAUSES
Primary Lactase Deficiency: This condition is very rare and occurs when babies are born with a deficiency or absence of the enzyme lactase. Babies inherit this condition by getting one gene that causes this problem from each of their parents, even though both parents may be lactose tolerant. These babies require a specialized formula with another type of sugar such as sucrose (present in table sugar), which they are able to digest.

Secondary Lactase Deficiency: The most common cause of temporary lactose intolerance in infants and young children is infection that affects the gastrointestinal tract and can damage the lining of the small intestine.

Rotavirus and Giardia are two common organisms that cause damage to the surface of the small intestine resulting in temporary lactose intolerance. Older infants and young children will commonly be infected by a rotavirus. The symptoms of rotavirus infection symptoms include vomiting, diarrhea (frequent, watery stools), and fever. Giardia is a parasite that is found in well water and fresh water from lakes and streams. Treatment of giardia infection with antibiotics will resolve the lactose intolerance.

Secondary lactase deficiency can also be due to Celiac disease, which is intolerance to gluten, the protein found in wheat, rye, barley and other grains. Crohn’s disease, an inflammatory condition that can affect any part of the gastrointestinal tract, can lead to secondary lactase deficiency as well. Once each of these conditions is treated, the lactase deficiency will resolve. The lactose intolerance usually resolves within three to four weeks when the lining of the intestines returns to normal.

Acquired Lactase Deficiency: Many individuals acquire lactose intolerance as they get older. It is estimated that approximately one-half of adults in the United States have acquired lactase deficiency. This condition is due to a normal decline in the amount of the enzyme lactase present in the small intestine as we age. Although lactose is an important part of the diet in infants and young children it represents only 10% of the carbohydrate (sugar) intake in adults. However, individuals who are lactose intolerant may not be able to tolerate even small amounts of this sugar in their diet.

Lactose intolerance occurs more frequently in certain families. One of the most important factors affecting the rate of developing lactose intolerance is an individual’s ethnic background. Approximately 15% of adult Caucasians, and 85% of adult African Americans in the United States are lactose intolerant. The rate of lactose intolerance is also very high in individuals of Asian descent, Hispanic descent, Native Americans and Jewish individuals.

DIAGNOSIS
Lactose intolerance is diagnosed by a simple test called a hydrogen breath test. After an overnight fast before the test, an individual breathes into a bag and then drinks a specified amount of the milk sugar in the form of a syrup. In adults this corresponds to the amount of milk sugar in a quart of milk. Subsequent breath samples are taken for up to three hours. The breath that they exhale into the bag is analyzed to determine its hydrogen content. During the course of the test individuals who are lactose intolerant will have an increase in the amount of hydrogen that they exhale. If the values for hydrogen increase above a certain value, the diagnosis of lactose intolerance is made. Patients who are lactose intolerant may also develop their typical symptoms during the test.

In younger children or in children who cannot tolerate the breath test, removal of lactose from the diet and possible supplementation with lactase can be done for 2-4 weeks to see if this improves the symptoms.

Treatment
The best treatment of lactose intolerance is a combination of dietary modification and taking a supplement to aid in digestion of lactose. Individuals who are lactose intolerant should meet with a dietician to review the sources of lactose in their diet. Some reduction in the daily lactose consumption is usually required. When an individual is going to be eating a food that contains lactose they should take a commercially available non-prescription lactase supplement at the time of lactose ingestion. This type of supplement can be taken throughout the day whenever lactose is ingested. Some individuals will be less lactose intolerant and therefore will be able to tolerate comparatively larger amounts of lactose. Alternatives to milk for lactose intolerant individuals include products such as soy milk. If an individual is restricting their milk/ dairy intake it is important to ensure adequate supplementation of calcium and Vitamin D in the diet. This is especially important for pediatric patients and women.

Recommended daily calcium intakes:
1-3 years of age: 500 mg
4-8 years of age: 800 mg
9-24 years of age: 1300 mg
Age 25 and above: 800-1000 mg
Pregnant and nursing women: 1200 mg

Author(s) and Publication Date(s)

Marsha H. Kay, MD, The Cleveland Clinic, Cleveland, OH, and Anthony F. Porto, MD, MPH, Yale University/Greenwich Hospital, Greenwich, CT – Updated December 2012.

Marsha H. Kay, MD, The Cleveland Clinic, Cleveland, OH, and Vasundhara Tolia, MD, Children’s Hospital of Michigan, Detroit, MI – Published September 2004.