Bowel disease - the environmental approach - much more logical than the conventional approach
It is astonishing that conventional medicine almost entirely ignores the role of food and diet in the diagnosis and treatment of bowel disorders. Serious diagnoses such as cancer obviously need to be excluded but then the environmental approach should be used to work out the root cause of gut symptoms.
Bowel symptoms are not very helpful in diagnosing causes. This is because pain in the gut is poorly localised and many symptoms can be caused by different disease processes. For example nausea can be caused by motion sickness, pregnancy, food allergy, chemical sensitivity etc. Bloating may be a symptom of gall bladder disease, food allergy, gut dysbiosis or constipation. Symptoms may, however, give useful clues about what to tackle first.
The environmental approach is to look for causes
There are three commom threads to follow in the treatment of most gut problems namely:
- diet (allergy and hypoglycaemia),
- poor digestion of foods and
- the fermenting upper gut or gut dysbiosis (wrong bugs in wrong place).
If things get complicated often all threads are involved! In order of probability the causes are:
The gut evolved over thousands of years dealing with a Stone Age Diet. This is what we should all eat! Issues of diet include hypoglycaemia and allergy. More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
Hypoglycaemia (low blood sugar)
Hypoglycaemia stimulates acid production. A common symptom is that when you feel hungry, the stomach rumbles!. Sugar, alcohol and caffeine all cause low blood sugar (hypoglycaemia). If there is no food to mop up this acid, it will damage the lining of the gut. Again this is a clinical diagnosis which is usually easy to make if the patient is honest about what he/she consumes. See Hypoglycaemia
Allergy to food
There are tests for food allergy but they are not very reliable with many false positives and negatives. The most reliable way to diagnose is to do elimination dieting. Start with the Stone Age Diet. More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
Gut dysbiosis - ie the wrong bugs in the wrong place
The upper gut should be sterile, like a dog's gut to digest protein and fat, and the lower gut should be fermenting, like a horse's gut, to digest fibre. This versatile gut allows humans to eat a wide range of foods and partly explains the success of homo sapiens! However Western diets, high is sugar and refined carbohydrate, lend themselves to upper gut fermentation which causes many digestive problems! See Fermentation in the gut and CFS
Gut dysbiosis can be tested for by a gut fermentation test, comprehensive digestive stool analysis, Metametrix Faecal Microbial Analysis stool test to see which bugs are present, urine test for hydrogen sulphide or breath testing for helicobactor pylori and others.
See - Hypochlorhydria
Poor eating habits
The gut is a creature of habit. It learns when to expect foods and prepares accordingly (think of Pavlov's dogs - see here Pavlov's dogs). Regular eating patterns are important with adequate amounts of food which requires digestion to "mop up" the acid produced in the stomach. Take time to chew - digestion of food starts in the mouth. Indeed chewing produces saliva which contains endothelial growth factor - this stimulates the gut lining to stay tight and prevent leaky gut.
Caused by too little fibre in the diet, or the wrong foods (dairy allergy is a comon cause), too little water, insufficient bugs in gut or wrong bugs (E.coli ferments to produce serotonin - essential for normal gut movement) or not enough exercise (exercise is a great laxative - ask any runner!). This is a clinical diagnosis. A normal person on a good diet should open their bowels daily (on average) and effortlessly (no straining) to produce a large (oh dear, I've never weighed a stool - about 10-12 inches long, thick as cucumber), soft, brown, fairly inoffensive poo - see Constipation
Drug Side Effects
(eg aspirin-like drugs, steroids).
Post mortem studies suggest that 17% of people taking aspirin-like drugs are bleeding from their gut. Consider doing a CDSA test. (Comprehensive Digestive Stool Analysis)
Digestive enzyme deficiency
(failure to digest)
This can be tested for by a Comprehensive Digestive Stool Analysis, which does the basics. You could also ask for faecal elastase (measure of pancreatic function), bile salts and salivary VEGF for Hypochlorhydria. Poor digestion may lead to absorption of short chain polypeptides which can act as hormone mimics causing a wide range of symptoms - these can be measured by the test short chain polypeptides - which is also a test for leaky gut.
Other often overlooked causes of gut symptoms include:
- Free radical damage - in the case of pancreatitis - see Antioxidants
- Poisoning - pesticides (cause gastritis)
- Poor blood supply to the gut - see Antioxidants
- Comprehensive Digestive Stool Analysis
- Faecal occult blood
- Elastase - a new test for pancreatic disease
- Helicobacter Pylori breath test
- Vascular endothelial growth factor (VEGF)- salivary test for hypochlorhydria
- Short chain polypeptides - another measure of protein digestion and absorption
- Stone Age Diet
- Fermentation in the gut and CFS
- Ketogenic diet - the practical details
- My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
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