|November 2002 Vol. 1 No. 11|
Chained to the Bathroom
We all can recall the painful distress from a bad case of the stomach flu or a bout with “traveler’s diarrhea.” Can you imagine this happening almost everyday – all day long? Unfortunately, for some people this is a way of life. They know where every bathroom is in every building in every town they visit. They fear going out of their home because of the sudden onset of stomach pains and an uncontrollable urge to move their bowels; followed by a torrent of diarrhea – sometimes accompanied by blood and mucus. This distress is most commonly due to inflammation of the large intestine (colon) and is called colitis. The cause can range from an infection with a bacteria, parasite, or virus to an allergic reaction from a disagreeable food. And the troublesome agent can come to the colon from the remnants of food flowing inside the intestine or through the bloodstream. When the colitis is short-lived there are usually no serious consequences – and people recover fully. However, there are chronic forms that never go away and are resistant to all the drugs modern medicine has to offer.
The reason that these forms never go away is because the cause of the colitis never stops. In other words, whatever is the source of the colitis continues to attack, injuring the body, and in this case most noticeably the colon. So the solution to this chronic condition is to find the offending agent and eliminate it. Modern medicine can do this in some cases of chronic parasite infections, like Giardia, with the use of antibiotics. But most cases of chronic colitis are incurable because the offending agent remains elusive.
Why is Chronic Colitis Incurable?
The main reason chronic colitis is rarely healed is because almost all practicing doctors believe that the foods we eat have little or nothing to do with the health of our intestine (or for that matter our entire body). They cannot imagine that what remains for hours and sometimes days in contact with the lining of our intestinal tract could have a thing to do with its health. This misunderstanding is as preposterous as a doctor believing that what people breathed had no affect on their lung health or that substances that contact a patient’s skins rarely caused skin disease.
So the first step in curing any chronic disease, including chronic forms of colitis, is to recognize that the most intimate contact the body, and especially the colon, has with the world around us – is our food. The second step is to understand that the rich American diet is the wrong food for people. Acceptance of these two premises is essential to solving common forms of colitis.
Chronic colitis can range from very mild and hardly noticeable to severe and life threatening – and all levels in between. However, the following discussion will artificially divide the colitis into mild and severe forms.
Mild Chronic Colitis
Mild chronic colitis is commonly known as irritable bowel syndrome (abbreviated IBS – also known as spastic colitis and spastic colon). This disorder accounts for nearly 50% of referrals to gastroenterologists. IBS affects mostly women and is seen in as many as 24% of women and 15% of men in Western societies.
The primary symptoms of IBS are abdominal pain, bloating, feeling of incomplete evacuation, and poor bowel function. This may present as either predominately diarrhea or constipation, or alternation between these two extremes. I learned in medical school that this was primarily a disease of “neurotic, middle-aged, women.” But, that was from my same doctor-mentors who taught me that diet had nothing to do with disease.
The idea that the mind can cause bowel disease has been one of the fundamental teachings for medical students and doctors for decades. We learn that stress will cause acid indigestion and stomach ulcers, and that IBS is a neurosis. Stop and think: the brain is a long way from the colon, and to make that conclusion over the more obvious one – that the food that bathes every inch of our intestinal tract is the cause – is a long stretch. Life is difficult with constant emotional challenges, but have faith that what you put in your intestinal tract determines its health.
Dietary Treatment of IBS
The contents of the intestinal tract – the American (Western) diet – are the obvious place to look for cause and cure of IBS. There are many qualities of this diet that make the intestine inflamed. This diet is high in fat, indigestible milk sugar (lactose), and low in dietary fiber, carbohydrates, and plant chemicals (phytochemicals). Many of the food proteins cause allergic reactions. Specific food intolerances are argued to be involved in as many as 58% of cases of IBS and the most likely offenders are milk, wheat and eggs. 1-4
Adding fiber to the diet of patients with IBS has shown to significantly improve their symptoms.6 Most of the experiments have been done using supplements of wheat bran or guar gum.7 Constipation is helped much more than the diarrhea-type of IBS with the addition of these fiber supplements.7 There are, however many different kinds of fibers in plant foods which have many functions in the bowel. Therefore, I have found the benefits from a change to a plant-based diet with hundreds of naturally healthy fiber to be much greater than those seen with a single fiber source.
IBS has also been effectively treated with the addition of “friendly intestinal bacteria,” called probiotics.8-10 Organisms used in one study, Lactobacillus plantarum, resulted in all patients reporting resolution of abdominal pain and half of them had relief of constipation.8 Eating a healthy, plant-based diet causes healthy bacteria to grow in the intestine, because these bacteria like to eat the plant sugars (oligosaccharides) found in starches, vegetables, and fruits.
My experience has been that a change to a low-fat, plant-based diet (a diet based on starches, vegetables and fruits) results in almost immediate relief of bowel cramps, diarrhea, and constipation. This is due to many qualities of the vegetable foods. For the very few people who continue to have symptoms, I will eliminate wheat – to which some people may be sensitive. As a last resort I will ask these people to follow an elimination diet. (A very effective elimination diet is found at www.drmcdougall.com under “Common Diseases, Allergic Diseases.”) It seems a shame to blame the patient by calling her neurotic when the intestinal tract is the obvious place to look for a solution.
Severe forms of colitis are known as inflammatory bowel disease (IBD) and encompass two categories of disease called ulcerative colitis (UC) and Crohn’s Disease (CD). These diseases resemble each other so closely that it is hard for doctors to distinguish between them and for practical purposes can be considered almost identical, since the cause and treatments are essentially the same. In a practical world, doctors do not know the cause and the treatments never cure the diseases; and all that is offered the suffering patients are temporary benefits with plenty of costs and side effects – in other words a multitude of medications.
IBD is a chronic inflammatory condition causing patients to suffer with abdominal pains, bloody diarrhea and mucus. The diagnosis is made when there is no other cause found by negative stool cultures for bacteria, ova, or parasites. This is an autoimmune disease, where the body attacks the bowel tissues.
Evidence for a Dietary Cause
IBD is found exclusively in societies where people eat the Western diet. Worldwide this disease is more commonly found in northern than southern populations – this trend parallels the consumption of the Western diet -- the incidence increasing worldwide as people change from unrefined plant-based diets to diets of meat, dairy products and refined foods.11
People with UC have been found to have higher intakes of animal protein than the general population has.12 Patients with high levels of antibodies to whole milk are more likely to have rapid relapses than are patients with low levels of these milk antibodies.13 A high intake of refined carbohydrates and a lower intake of fruits and vegetables has been associated with Crohn’s Disease.14-15 Patients with UC are likely to have symptoms induced by cow’s milk. 16 A study from Japan of UC patients found that margarine or chemically modified fat may play a role in the development of ulcerative colitis.17
Sulfur compounds may also play an important role in the cause of IBD. Hydrogen sulfide has been found to be toxic to the cells of the colon.19-20 This substance is produced in the bowel by the action of bacteria on dietary sources of sulfur – more specifically, sulfur-containing amino acids. Animal products are the main sources of these amino acids.21 Compare the relative amounts of methionine, a common sulfur-containing amino acid, in these foods (based on calories):
Beef provides 4 times more than pinto beans
Eggs have 4 times more than corn
Cheddar cheese has 5 times more than white potatoes
Chicken provides 7 times more than rice
Tuna provides 12 times more than sweet potatoes (Giving a whole new understanding of “fish farts.”)
Dietary Treatment of Severe Colitis
Very basic diets consisting of mostly sugar and water called elemental diets have been found to be very effective at relieving acute flare-ups of Crohn’s Disease. Possibly their benefits come from the fact that they contain no intact protein to cause an autoimmune reaction with the gut. One study compared formulas with no intact protein with another formula with intact milk protein. Remission was found in only 36% of those taking the formula with milk protein, but 75% on the protein-free formula.22
In one recent large scale controlled study, 93 unselected patients with CD followed an elimination diet and 84% achieved remission after 2 weeks. Food intolerances discovered were predominately cereals, dairy products and yeast.23 However, only about 40% remained in remission after 2 years and this was largely due to poor compliance with the diet. A previous study of self-selected (therefore, more compliant) patients had shown that two-thirds of patients treated with diet were well after 2 years.24 Many other studies have found significant benefits from treating patients with IBD by a healthy largely plant-based diet that eliminates or reduces the intake of animal protein and/or fats.25-30
An important study was performed with Crohn's Disease patients who had been suffering from severe diarrhea for many years, with 20 stools or more per day.31 The subjects were changed from a high-fat diet to one low in fats. This gave relief from the frequent watery stools within two to three days. Most patients continued to form solid bowel movements-as long as they kept the animal and vegetable fats out of their diet.
A person with a functioning healthy small intestine re-absorbs the bile secreted from the liver in the last part of the small intestine, called the ileum. In patients with Crohn's Disease, this portion of the ileum often is damaged and unable to absorb the bile. Bile continues to flow through the ileum into the large intestine, where it causes irritation and discharge of mucus and water. In these patients, the immediate benefit from a change in diet is the decrease in bile acids produced by the liver as a response to lowering the fat content of the foods eaten. In addition, the fibers introduced in a plant-based diet bind and neutralize many of the bile acids and absorb free water present in the stool.
Diet for the Treatment of Chronic Colitis
Obviously, the contents of the bowel must have a determining effect upon its health. Therefore, logic dictates that a person wishing to keep his/her bowels healthy should put good foods in them. Whether it is heart disease, cancer, obesity or diabetes that is being discussed, the diet that is recommended is a diet high in complex carbohydrates and low in animal foods and fats – in other words a plant-based diet. There should be no surprise that the same diet is “bowel-healthy” too.
I believe the best diet for preventing and treating all forms of colitis is based upon starches with the addition of fruits and vegetables. This diet is also devoid of all free fats (all vegetable oils) and all animal products. If this fails to resolve the problems then the next step is to eliminate wheat products. Finally, the elimination diet should be tried to search out any offending foods. With this approach I have seen most people with colitis improve and many cured of their conditions – including those with the more serious forms of IBD. There is no reason not to believe this and try a healthy diet for a period of time (say 4 months). There are no added costs and no side effects from this approach and there is a real possibility of excellent health being the result.
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