Wednesday, April 30, 2008

About Intestines

Sherri's comment spurred some thoughts I have about intestines, primarily the colon or large intestine. Lots of good thinking to do about intestines. Nothing subtle about them.

Irritation and inflammation of the large intestine are common. It makes sense, though, that such an indispensable organ (system) would be capable of such patent communication.

Symptoms involving the colon range from mild to severe. They can be intermittent or chronic. The causes are myriad. They include one or a mix of ... a bacterium, a virus, a parasite, yeast, a particular food or foods, supplements and drugs, a stretched stomach, hormones, an immune issue, certain mental states. (90% to 95% of the serotonin in our body is in the GI tract, not the brain. There are different kinds of receptors though, and different kinds of drugs based on those receptors.)

There are structural changes that can cause problems too: diverticula (out-pouches), narrowing of the lumen, polyps and lesions. If the cause of symptoms can be determined, a diagnosis can be made. That's sometimes difficult to do, even when you look inside, or view cells under a microscope, or check for antibodies. Because there are so many factors ... overlapping, synergistic, episodic. Gastroenterology is a fascinating field.

Less severe colon conditions include Irritable Bowel Syndrome (IBS). IBS can be managed (after you get rid of any infective agent) through a process of elimination of foods/beverages*, increased soluble fiber, probiotics, relaxation exercises, adequate sleep, and other lifestyle changes. There's a whole list of foods (and other things we put in our mouth) that may be causative or exacerbating, it's very individual. (Dairy, citrus, and fried foods come to mind.)

Once the GI lining is irritated and inflamed, for whatever reason, it's especially helpful to limit fat.
  1. A damaged intestinal lining (especially the ileum and proximal colon - closer to the small intestine) reduces the uptake of bile. Bile acids linger in the colon causing pain and diarrhea by themselves (in addition to the primary cause of irritation), not to mention increasing the risk for cancer. Since fat intake promotes bile secretion, it's best to avoid it.
  2. Limiting fat reduces fatty stools during malabsorption.
  3. Limiting fat reduces the gastrocolic reflex, the urge to go.
If you're wondering about symptoms, the Rome Criteria is used to diagnose IBS.

More severe cases of inflammation are grouped under Inflammatory Bowel Disease (IBD). They include Ulcerative Colitis (UC) and Crohn's disease. Crohn's disease is thought to be an autoimmune disease; as such, it can be managed but cannot be cured. Ulcerative Colitis (distinct from nondescript colitis) can be cured by colon removal. (Celiac disease is an autoimmune disease of the small intestine. It may or may not cause symptoms in the large intestine. It is distinct from a wheat allergy. Like Crohn's, it can be managed but cannot be cured.)

Celiac Disease and the IBDs: UC and Crohn's, are more apt to involve weight loss and blood in the stool (thus anemia) than IBS. However, IBS can coexist with celiac and the IBDs.

* Since IBS involves the various nervous systems (central, autonomic), it's difficult to narrow down offending foods. One time a food may go down well (if you're not stressed), another time it may not (if you're under the gun). Also, a placebo effect may be working ... the belief that a food is offending can be enough to make it offending, with corresponding physical effects.
Photo from Fun Fever blog. Many more there.
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Dr. Mel said...

Sorry to be going back so far here, but I was looking to see if you had info on celiac or gluten sensitivity. Most of what I've read online suggests that gluten sensitivity is just a step along the way to celiac, but, interestingly, you seem to say that they (celiac/what allergy) are not related (if I'm interpreting what you say correctly).
In that vein, I wondered if you had any knowledge (vis a vis gluten sensitivity) of a stool sample test for gluten sensitivity, which claims to detect such sensitivity sooner than it can be seen in bloodwork. Here is a lab that does the tests, which look for certain antibodies in the stool sample:

Bix said...

Celiac and wheat allergy are distinct, yes. I know celiac as an autoimmune disease, not an allergy. With an autoimmune disease, our body attacks itself. With an allergy, our body attacks a foreign substance. You can grow out of or lessen effects of an allergy. You can't grow out of an autoimmune disease, but you can manage it.

The two can occur together too. Celiac can be diagnosed well with a biopsy of the small intestine. (The intestine atrophies.) Wheat allergy on the other hand has a lot of the allergy symptoms like hives, respiratory problems.

There's a lot more to know about these and related disorders. I don't know a lot. I've heard testing stool is not always reliable. But I really don't know.

BTW, Autumn (in my People list to the right) is probably a great resource for all things gluten.

Dr. Mel said...

Thanks Bix for your help--I've contacted Autumn!

Dr. Mel said...

Hey Bix, thanks for the referral to Autumn. She gave me a great explanation of gluten sensitivity and how it works in the gut, and also offered an opinion on EnteroLab!

Bix said...

That's great. I hope things things work out okay.

Autumn looks to have a nice practice going. I'm happy for her.