In December my brother David and I attended the Crohn’s and Colitis Foundation of America conference. David is a gastroenterologist and I am involved in conducting Crohn’s and colitis clinical research. We had a great time hanging out together and attending lectures. And, of course, I was inspired to collaborate with David on a “gut” themed newsletter this month!
Inflammatory Bowel Disease
At the conference Peter Higgins, MD, PhD, lectured about the dietary management of inflammatory bowel disease (IBD). Related to diet and risk of IBD, he cited a systematic literature review published in the American Journal of Gastroenterology in 2011 that concluded:
- High dietary intakes of total fats, polyunsaturated fatty acids, omega-6 fatty acids, and meat were associated with an increased risk of Crohn’s disease (CD) and ulcerative colitis (UC)
- High fiber and fruit intakes were associated with decreased CD risk, and high vegetable intake was associated with decreased UC risk
Dr. Higgins does not believe there is sufficient evidence generated from randomised controlled trials to show diet can control bowel inflammation. These diet studies are rarely conducted because they are very difficult and expensive. And since there would be no patented product to promote at the end, there is little incentive for industry to fund the studies.
But to possibly reduce the symptoms of IBD he suggests a bland diet during a flare of symptoms (with a return to a full diet), a low FODMAP diet for selected patients and a low residue diet for patients with narrowing of the bowel. He also advocates for the maintenance of protein and calorie intake, as well as adequate hydration.
If you or someone you know suffers from IBD, take a look at the summary info on treating UC with diet and achieving remission in CD. It helps to be aware of the best available evidence.
Pre-biotics primer: we feed the good bacteria* in our gut, and they feed us right back. They take the pre-biotics we eat, like fibre, and in return provide the vital fuel source – butyrate – that feeds the precious cells that line our colon. The bad bacteria residing in our gut on the other hand are not so helpful. Our bodies must maintain a balance between tolerating good bacteria while attacking the bad bacteria. But how?
It turns out that the butyrate made by good bacteria from the fibre we eat may also act as a microbial signal to inform our immune system that the relative levels of good bacteria are within the desired range, thereby suppressing an inflammatory reaction. Without fibre, the good bacteria don’t make butyrate and our immune system may start attacking beneficial bacteria. This could lead to inflammatory bowel disease where our immune system is in constant red alert attack mode.
The minimum recommended daily intake of fibre is about 30 grams. Foods high in fibre include beans, lentils, whole grains, berries and vegetables. Keep in mind animal products contain no fiber. And whole foods rather than fibre supplements are generally better. Fibre supplements — such as Metamucil — don’t provide the variety of fibers, vitamins, minerals and other beneficial nutrients that foods do.
*Good bacteria are also known as “pro-biotics”.
Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal discomfort and altered bowel habits. Nine randomized placebo-controlled studies have found peppermint oil to be a safe and effective treatment for IBS, suggesting it might be a reasonable approach for clinicians as a first-line therapy, before trying anything else. Find more information here.
Constipation is the most common gastrointestinal complaint in the United States leading to millions of doctor visits every year. The researchers who published a large study concluded here that being vegetarian especially vegan, is strongly associated with a higher frequency of bowel movements (BMs). Vegans were about 3 times more likely to have daily BMs.
Gastro-esophageal reflux disease (GERD), often referred to as acid reflux, is one of the most common disorders of the digestive tract. The two most typical symptoms are heartburn and regurgitation of stomach contents up into the back of the throat. It causes a huge number of doctor visits and trips to the ER due to fears over heart attack-like symptoms. It can lead to hospitalisations for bleeding, food boluses from strictures and rarely esophageal cancer.
In general high fat intake is associated with increased risk whereas high fiber foods appear to be protective. The reasons fat intake may be associated with GERD symptoms and erosive esophagitis is because studies on volunteers have shown that when we eat fatty foods, the sphincter at the bottom of the esophagus that’s supposed to keep the food down is relaxed in the presence of fat, and so more acid can creep up into the esophagus. Click here for more info about diet and GERD.
Black Beans and Rice
I’ve been enjoying this dish for many years. Not only is it full of fibre, but it doesn’t require fresh ingredients. I usually have all the ingredients on hand so can make this without advance planning. Moreover, It is very easy to prepare. Serve it over brown rice…my preferred brand is Lundberg (brown short grain or brown basmati). Find it at most non-discount grocery stores (e.g. Loblaws) and health food stores.
1 cup uncooked brown rice
1 19-ounce can black beans
1 28-ounce can tomatoes
1/4 cup (or to taste) chopped hot peppers from can or jar
1/4 cup barbecue sauce
3/4 tsp cumin
2 cups frozen corn
salt and pepper
Cook rice according to package instructions. Meanwhile, in a colander rinse and drain beans. In a separate medium saucepan, combine beans, tomotoes (chopped), chilies, barbeque sauce and cumin. Bring to boil; reduce heat to medium-low and summer 5 minutes. Add corn and salt and pepper to taste. Simmer 5 minutes or until corn is tender. Serve beans and sauce over rice and enjoy!
Makes 4 servings.