Excerpt:

A possible cause of irritable bowel syndrome has been traced to a small piece of RNA that blocks a substance protecting the colon membrane, leading to hostile conditions that can produce diarrhea, bloating and chronic abdominal pain.

New research shows that this RNA segment sends signals that stop the activity of the gene that produces glutamine, an amino acid. Previous research has linked a shortage of glutamine in the gut with the seepage of toxins and bacteria through the intestinal wall, irritating nerves and creating disease symptoms.

Scientists say that trying to generate glutamine in the disordered bowel by silencing this RNA segment could open up a whole new way of thinking about treating the diarrhea-predominant type of irritable bowel syndrome (IBS). In the meantime, they are making plans to conduct a clinical trial to see if glutamine supplements could also reduce common IBS symptoms

This form of the disorder is characterized by diarrhea and bloating as well as chronic abdominal pain that is difficult to treat. About a third of IBS patients have the diarrhea-predominant type, another third experience consistent constipation, and the rest experience alternating bouts of diarrhea and constipation.

Posted: 02/12/2009

Case 1

Mr. X is a healthy, active 33-year-old man who travels frequently for his job as a sales representative. He has a history of 1 depressive episode, which occurred at age 24 when he was attending graduate school. He was treated over a 6-month period with a selective serotonin reuptake inhibitor (SSRI), and he has not had a recurrence since. In his late 20s, he was diagnosed with constipation-predominant irritable bowel syndrome (IBS). Until recently, he was able to control his symptoms by carefully managing his diet, which he did by maintaining a high fiber intake and by avoiding foods that trigger his symptoms. His workup at the time of diagnosis by a gastroenterologist included colonoscopy and other laboratory tests to exclude other bowel pathology.

Over the past year, the IBS has increased in severity, resulting in cyclical constipation and associated abdominal spasms every 3 to 6 weeks. The IBS has begun to interfere with his work productivity, because he must take time off every few months. He has tried lactulose as a laxative, and he has increased his bran fiber intake, but there has been no improvement.

He is seeking control of his symptoms, but he prefers to try dietary measures before resorting to medications. He has no symptoms of depression and no recent major life stressors, other than a heavy workload. There are no bowel symptoms suggestive of peptic ulcer disease. Similarly, there are no “red flags” or systemic symptoms, such as weight loss, that would suggest the presence of other chronic diseases.

The physical examination reveals a healthy, young man with a body mass index of 26. The cardiovascular and respiratory examinations are normal. The abdominal examination, on deep palpation, reveals slight tenderness over the large bowel, mild distension, and an absence of masses. The rectal examination is normal, and test results for occult fecal blood are negative. The mental status examination is normal, and the constipation and associated abdominal spasms within normal limits.

What are some options for improving his symptoms?

Case 2
Mrs. Y is a 44-year-old woman with diarrhea-predominant IBS that was diagnosed a year ago after she underwent a complete gastroenterologic workup to exclude other pathologies. Her symptoms are persistent, and this causes her inconvenience at work, limits her social activities, and affects her ability to perform daily functions. Because of her IBS, she leads a sedentary lifestyle.

She has tried an anxiolytic for the abdominal pain and loperamide for the diarrhea, but the abdominal distension, bloating, and painful spasms continue. She takes fiber in various forms, including Metamucil® and wheat bran, but the fiber supplements do not seem to control the diarrhea. She admits that life is stressful and has been in counseling for a few months.

What else can she try to better control her IBS symptoms?

Gluten sensitivity, does everyone have some tendency to this common affliction? It is great to have gluten free foods becoming widely available and Harvard admitting this is hard to rule in or out. Not everyone has the classic symptoms yet this can be contributing to poor health for many people.

Now the hot button they are not touching is the issue about the epidemic Of AUTOIMMUNE DISEASE, as the book by Donna Nakazawa has so forcefully covered. That ties in to diseases where my F.I.G.H.T. program can be helping over 29 million who are afflicted with any one of the more than 100 entities now known to be autoimmune related.

What about leaky gut?  What about the need for probiotics and the right kind of fiber as found only in my opinion in Beyond Fiber? But will anyone dare mention avoid GMO foods? Can anyone at Harvard connect the dots between BACILLUS Theringensis, which kills insects by ripping apart their intestines and the rapidly developing epidemic of food sensitivities that are contributing to so many chronic health problems? At least Harvard has part of the story!  There is a major problem with food related diseases.

Sincerely,

Garry F. Gordon MD,DO,MD(H)
President, Gordon Research Institute
www.gordonresearch.com

Notable from Harvard Medical School

** The Sensitive Gut

Have you ever wondered why your stomach feels queasy when you’re nervous or why emotions sometimes roil your intestines? If so, you are experiencing the symptoms of the gut-brain connection. The Sensitive Gut describes the many gastrointestinal conditions that are caused or at least exacerbated by stress, emotion, anxiety, and other brain-to-gut messages. Irritable bowel syndrome, heartburn and reflux, dyspepsia, and even gas and constipation are described here along with self-help and medical treatments.

Getting out the gluten

Celiac disease (an autoimmune disorder whose symptoms are triggered by gluten, the protein content in wheat, barley, rye, and spelt ) is on the rise. That’s one reason for the rise in popularity of gluten-free food.
Celiac specialists say the disease isn’t diagnosed as often as it should be. As a result, many people suffer with it for years, often after getting other — and incorrect — diagnoses and useless treatments.
But a growing number of the people dodging gluten fall into a gray area: they don’t have celiac disease but seem to be unable to digest gluten properly. There are no tests or strict criteria for this problem, aside from simple trial and error with a gluten-free diet. Some people may be getting caught up in a food fad. But many others probably do have trouble digesting gluten or perhaps the sugars in some of these grains (like the lactose intolerance that makes it hard to digest dairy foods).

Do you have a gluten problem?
The classic and most immediately noticeable symptoms of celiac disease are, not surprisingly, gastrointestinal: bloating, flatulence, and diarrhea, sometimes with smelly stools. People who can’t digest gluten or grain sugars may have similar symptoms.
Celiac disease can severely impair the absorption of nutrients. In children, this may lead to stunted growth; in adults, the consequences include anemia (because iron isn’t being absorbed) and weaker bones (because calcium and vitamin D aren’t getting into the body). Anemia causes fatigue and malaise, but some people with celiac disease feel that way without anemia.
Doctors sometimes miss the celiac disease diagnosis because they’re looking for the classic gastrointestinal symptoms, not the vaguer ones that stem for the most part from malabsorption of nutrients.
One major difference between celiac disease and grain-related digestion problems is that when it’s just a digestion problem it typically doesn’t lead to malabsorption and nutritional deficiencies.
Women with untreated celiac disease have higher-than-normal rates of menstrual abnormalities and infertility. A large study published in 2007 found an increased risk of pancreatitis in people with celiac disease. It’s not clear whether these associations suggest a cause-and-effect relationship or if celiac disease and these conditions happen to share an underlying cause.

Grains for the gluten-challenged
We’re often too quick to depend on pills instead of first working to change our diet and exercise habits. But with celiac disease, there’s no pill, and a fairly radical change in diet is the only treatment. Drug companies have started to take some interest in the disease, and treatments that would block the absorption of gluten are being investigated, but none so far are close to gaining FDA approval.
Until you need to avoid gluten, you probably don’t realize how ubiquitous it is. Gluten is used as a thickening agent and filler in everything from ketchup to ice cream. The inactive ingredients in many medications are gluten-based. And even when gluten isn’t an ingredient, it may inadvertently get into a food because a wheat-based food was processed in the same factory, or wheat was grown in a nearby field. At home, wooden utensils and toaster ovens are gluten “hot spots.” Oats don’t contain gluten, but many people with celiac disease avoid them because of contamination problems.
The gluten-free diet has traditionally depended on starch from rice, corn, and potatoes. Food makers have also learned how to use xanthan and guar gums to replace gluten’s elasticity: a common complaint about gluten-free baked goods is that they are powdery. But these formulations can also leave diets short of fiber and B vitamins. Melinda Dennis, the nutrition coordinator at the Beth Israel Deaconess Medical Center Celiac Center, encourages patients to eat foods made with unconventional but nutritionally well-rounded substitutes, including amaranth, buckwheat (no relation to wheat), millet, quinoa, sorghum, and teff. She calls them the “super six” because of their high vitamin and fiber content.
Eating out is one of the biggest issues for people with gluten problems. Vegetables get contaminated because they are steamed over pots of pasta water. Fish and chicken are floured to hold seasonings. But many restaurants are beginning to offer gluten-free items. And there are some celiac-friendly cuisines, even if they are not overtly gluten-free. Ethiopian (which uses teff), Indian, Mexican, and Thai are good possibilities.

For more information on common digestive disorders, order our Special Health Report, The Sensitive Gut, at www.health.harvard.edu/SG.