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How Diet Affects IBS: Tips for Better Digestive Health

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.

What To Do When You Experience Bloating

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!

Acute and Chronic Diarrhea: A Brief Review

By Steven G. Desautels, MD

Diarrheal diseases represent one of the five leading causes of death worldwide and are a particular concern for children younger than five years old in resource-limited settings.

Diarrhea may be defined as the passage of loose or watery stools, typically at least three times in a 24-hour period. Objectively, it is defined as stool weight exceeding greater than 200 grams per day. It reflects increased water content of the stool, whether due to impaired water absorption and/or active water secretion by the bowel.2Normally, the small intestine and colon absorb 99% of both oral intake and endogenous secretions from the salivary glands, stomach, liver, and pancreas. This constitutes a total fluid load of roughly 9 to 10  liters daily. Of the 10 liters of fluid that enters the jejunum (small intestine) daily (2 liters from food and drink and 8 liters from salivary, gastric, biliary, and pancreatic secretions), the majority is absorbed before entering the colon. Approximately one liter enters the colon with 80-100 ml excreted daily.  Diarrhea results when a disruption of this normally fine-tuned mechanism. A reduction of water absorption by as little as 1% can result in diarrhea.3

The following definitions have been suggested according to the duration of symptoms:

  • Acute – 14 days or fewer in duration
  • Persistent diarrhea – more than 14 but fewer than 30 days in duration
  • Chronic – more than 30 days in duration

Globally, diarrhea kills 2,195 children every day, more than AIDS, malaria, and measles combined.

Diarrheal diseases account for 1 in 9 child deaths worldwide, making diarrhea the second leading cause

of death among children under the age of 5. 2

ACUTE DIARRHEA

Approximately 179 million cases of acute diarrhea occur each year in the United States.4  Taken together, most cases of acute infectious diarrhea are likely viral. Among those with severe diarrhea, however, bacterial causes are responsible for most cases. Protozoa are less commonly identified as the etiologic agents of acute gastrointestinal illness. Noninfectious etiologies become more common as the course of the diarrhea persists and becomes chronic.

Infectious causes of acute diarrhea

Viral

Norovirus, Rotavirus, Astrovirus

Bacterial

Salmonella, Campylobacter, Shigella, C. diff, E. coli

Parasitic

Cryptosporidium, Giardia, Cyclospora, Entamoeba

Noninfectious causes of acute diarrhea

Medications

Antibiotics, antacids, antihypertensives, NSAIDS, antidepressants

Toxins

Organophosphate insecticides

Ischemic colitis

Fecal impaction

Most episodes of acute diarrhea are mild and self-limited, however, further evaluation should be pursued if any of the following apply:

  • Profuse diarrhea with dehydration
  • Bloody stool
  • Fever >38.5 (101.3)
  • Duration > 48 hours without improvement
  • Recent antibiotic use
  • Community outbreaks
  • Immunocompromised patients
  • Abdominal pain in patients >50
  • Elderly

CHRONIC DIARRHEA

Chronic diarrhea affects approximately 3 to 5% of the US population at any given time..  A much more extensive differential diagnosis exist for chronic vs acute diarrhea. The principal causes of chronic diarrhea vary based upon the socioeconomic status of the population. In resource-rich settings, irritable bowel syndrome, inflammatory bowel disease, and malabsorption syndromes (e.g., lactose intolerance and celiac disease). Whereas, in resource-limited settings, chronic bacterial, mycobacterial, and parasitic infections or more prominent. However,  functional disorders, malabsorption, and inflammatory bowel disease are also prevalent. Characterizing the diarrhea as infectious, inflammatory, osmotic, or secretory is a useful way to guide evaluation and subsequently elucidating a diagnosis by focused testing. The distinction between types of diarrhea can often be made based upon the medical history but in other cases may require additional laboratory, radiographic and endoscopic evaluation.

 

Differential diagnosis of chronic diarrhea
Watery diarrhea
A. Osmotic:
Medications Osmotic laxatives (Mg, SO4, PO4)
Unabsorbed sugars Diet foods/drinks/gum (sorbitol); enzyme deficiencies (lactase/sucrase)
B.Secretory:
Medications Stimulant laxatives, antibiotics, many others
Small intestinal bacterial overgrowth
Endocrine
Tumors Carcinoid, gastronome, medullary thyroid cancer, VIPoma
Systemic Adrenal insufficiency, hyperthyroidism
Bile salt malabsorption Postcholecystectomy, Ileal resection
Non-invasive infections Giardia, Cryptosporidium
Fatty diarrhea
A. Maldigestion Decreased duodenal bile salt concentration (bile duct obstruction, ileal resection).  Pancreatic dysfunction
B. Malabsorption Mucosal disease (celiac sprue, giardiasis, Whipple’s disease)
Inflammatory diarrhea
A. Inflammatory bowel disease Crohn’s, Ulcerative Colitis
B. Malignancy Colon cancer, lymphoma
C. Radiation colitis/enteritis
D. Mastocytosis
E. Infections C. difficle, CMV, Entamoeba
F. Ischemia

 

If you are suffering with ongoing diarrhea, please contact one of our specialists at Granite Peaks Gastroenterology in Sandy or Lehi.

Acute Gastroenteritis – Stomach Flu or Worse?

By Scott Moffitt, PA-C

Acute gastroenteritis, more commonly known as the stomach flu or food poisoning, is an infection of the stomach and intestines which is usually caused by a virus, the most common being norovirus. You may have heard of this virus being the culprit of GI illnesses associated with cruise ships or other large outbreaks. These viruses are passed person to person by contaminated food and water, or by objects we come in contact with. In the winter and spring months, infections usually peak because people are indoors and there’s more opportunity to pass the virus to uninfected persons. Less commonly, gastroenteritis can also be caused by bacteria such as salmonella, C. difficile and others.

Gastroenteritis Symptoms

Common symptoms of gastroenteritis include fever, body aches, abdominal pain, diarrhea and vomiting. Patients generally develop symptoms within 12-24 hours of being exposed, and the initial presentation can be quite severe, leading to the nickname 24-hour stomach flu. Luckily, viral gastroenteritis has a short course and most patients can expect a full recovery within 2-3 days.

Gastroenteritis Treatment

There is no specific treatment for patients with acute viral gastroenteritis. A short course of antibiotics may be needed for patients who have gastroenteritis due to bacteria that has been confirmed with stool studies. If patients do not have any of the alarm symptoms discussed below, medications such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol) may reduce the severity of symptoms. It is important to stay well-hydrated with sports drinks and broths to maintain electrolyte balance. Smaller, bland meals such as soups, crackers, potatoes rice, and bananas will generally be best tolerated. Patients should avoid sugary foods and drinks as these can worsen the diarrhea. In severe cases, some patients with prolonged nausea and diarrhea may become dehydrated to the point they need IV fluid repletion.

Alarm Symptoms

If you have concerning symptoms of gastroenteritis, you may be wondering when you should seek treatment. As mentioned above, viral gastroenteritis usually has a short course that does not require any specific treatment; most patients will clear the virus on their own. That being said, there are some symptoms patients need to watch out for and seek medical care if they develop, as it is important to rule out more serious causes of diarrhea and abdominal pain. These symptoms include:

– blood or pus in your stool
– uncontrolled vomiting
– prolonged symptoms lasting longer than one week
– weight loss
– if you are pregnant
– recent hospitalization or antibiotic use within the past 6 months
– if your immune system is suppressed from medications or chronic conditions, such as diabetes

In these cases, the specialists at Granite Peaks Gastroenterology may need further diagnostic studies, such as stool tests, blood work or an endoscopy procedure to determine an accurate diagnosis and consider proper treatment. Disease processes such as inflammatory bowel disease (Crohn’s Disease and Ulcerative Colitis), C. difficile infection, microscopic colitis, diverticulitis and celiac disease can have overlapping features with acute gastroenteritis and must be ruled out in patients with alarming symptoms.

If you have lingering symptoms with no improvement, talk to one of the GI specialists at Granite Peaks Gastroenterology. They can evaluate your symptoms and determine the best way to help you get back on your feet and feeling your best.

Microscopic Colitis: Causes and Treatment

By Steven Desautels, MD

Microscopic colitis is a chronic inflammatory disease of the colon that is characterized by watery, non-bloody diarrhea. Microscopic colitis should be suspected in patients with chronic diarrhea without a clear cause. There is a female predominance and the median age at diagnosis is approximately 65 years. Colonoscopic investigation reveals an endoscopically normal-appearing colon; however, biopsy evaluation demonstrates either a collagenous or lymphocytic colitis.

Collagenous colitis is characterized by a sub epithelial collagen band > 10 mm in thickness with lymphocytic colitis demonstrating an intraepithelial lymphocytic infiltrate (>20 per high power field).

Microscopic Colitis Causes

The cause of microscopic colitis is unknown, but it is likely to be related to a multitude of factors, including mucosal immune responses to luminal factors and various medications (e.g. non-steroidal anti-inflammatory drugs, Proton pump inhibitors, Sertraline and Clozapine).

Treating Microscopic Colitis

Antidiarrheal medications may be used in patients with mild diarrhea, but for patients experiencing greater than three stools per day or greater than one water stool daily, budesonide is usually required. The dosing of budesonide is associated based on the clinical response, and usually only requires short-term treatment courses. Patients are advised to avoid non-steroidal anti-inflammatory medications, and, if possible, discontinue medications associated with microscopic colitis. In very rare, refractory cases, anti-tumor necrosis factor (TNF) agents may be necessary.

The gastroenterology specialists at Granite Peaks Gastroenterology can evaluate patients experiencing chronic diarrhea, determine the cause of the symptoms and treat appropriately based on test results.

C. Difficile Infection

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.

Are you Lactose Intolerant?

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.

Management of Acute Diarrhea

Management of Acute Diarrhea

Source: Adapted from the American College of Gastroenterology

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