GASTRIC GOLD'S BLOG

What evidence supports the recommendation that patients with diverticulosis avoid nuts, popcorn, and other high-residue foods?

A patient comes to her physician for instructions consequent to the discovery of diverticular disease. She is cautioned to avoid high-residue foods, such as nuts, seeds, popcorn, and corn either on or off the cob, because the by-products of these foods might lead to trauma or obstruction at the diverticular opening in the colon, resulting in brisk bleeding or infection.

For a long time, this clinical scenario has represented common practice. The problem is that the recommendation to avoid high-residue foods may seem rational at first glance, but it lacks empiric proof. In addition, one of the proscribed foods, nuts, actually has a number of health benefits.¹

A REVERSAL OF A LONG-ACCEPTED PRACTICE

A cohort study of 18 years’ duration that included 47,228 men, aged 40 to 75 years, addressed the practice of advising patients with diverticular disease to avoid high-residue foods.¹ At the outset of the study, all participants were free of diverticula. During follow-up, there were 801 cases of diverticulitis and 383 episodes of diverticular bleeding in those enrolled.

The surprising finding in this study was that there was an inverse association between the consumption of nuts and popcorn and the risk of diverticulitis. Compared with men who had the lowest intake of these foods, those with the highest intake of nuts had about a 20% decrease in the risk of diverticulitis and those with the highest intake of popcorn had about a 28% decrease. Corn, either on or off the cob, neither increased nor decreased the risk of diverticulitis. Finally, there was no association between any of the high-residue foods and diverticular bleeding.

WHAT TO TELL PATIENTS

Tell patients with diverticular disease that nuts and popcorn actually decrease the likelihood of diverticulitis and that nuts have a number of other health benefits. For most patients with this common malady, this will be welcome news.

Labels: diverticulosis

Bacteria naturally present in the human gut could produce substances that help to protect against colon cancer and provide therapy for inflammatory bowel disease. In a paper published in the journal Microbiology, researchers from the University of Aberdeen Rowett Institute of Nutrition and Health and from the MTT Agrifood Research Institute in Finland report initial studies showing that bacteria in the human gut convert linoleic acid, a naturally-occurring fat in the diet, into a form called conjugated linoleic acid (CLA) which is absorbed by the gut wall.

There are different types of CLA and not all of them have beneficial effects. The "good" form of CLA is present in dairy foods such as milk and cheese," said Dr John Wallace of the Rowett Research Institute, "but eating lots of dairy foods won't necessarily help our gut health as most of the fats are digested in the small intestine before they get to the large intestine, where most of our gut bacteria are found." The results of these latest studies showed that several different forms of CLA are produced by gut bacteria. Fortunately, most was of the "good" kind, but Dr Wallace stressed that more extensive studies are needed. One subject produced small amounts of a CLA whose beneficial or otherwise effects are much less clear.

The implications are that, if small quantities of dietary linoleic acid can be delivered to the large intestine, the effects on gut health will be generally beneficial in most people. He added, "The results are of special interest for individuals using anti-obesity treatments that prevent the small intestine from absorbing fats. This means that those fats - including linoleic acid - will pass into the large intestine and the gut bacteria will produce CLA. It has to be the correct CLA, so it is important to understand how individuals produce different CLA. This must depend on which types of bacteria are present."

Labels: Cancer, IBD, Inflamatory Bowel Disorders, Irritable Bowel Syndrome

The following is a statement in response to the breaking news about Supreme Court Justice Ruth Bader Ginsburg being diagnosed with pancreatic cancer from Julie Fleshman, President and CEO of the Pancreatic Cancer Action Network, the only national organization creating hope in a comprehensive way through research, patient support, community outreach and advocacy for a cure.

"Our thoughts are with Justice Ginsburg as we learn of her pancreatic cancer diagnosis and subsequent surgery and we wish her well on her recovery.

"The diagnosis of pancreatic cancer in the early stages is encouraging news for all patients. However, only 20 percent of patients are diagnosed early enough to qualify for surgery. The incidental discovery of pancreatic cancer in Justice Ginsburg reminds us of the urgent need for additional research funding to find early detection methods for the fourth leading cause of cancer death in the United States.

"The Pancreatic Cancer Research and Education Act (H.R. 745) was introduced in Congress last week by U.S. Representatives Anna Eshoo (D-CA) and Ginny Brown-Waite (R-FL) and is the first substantive legislative effort dedicated to advancing pancreatic cancer research and addressing the critical needs facing our research community. Once enacted and fully funded it will provide a greater focus on this disease and will provide the National Cancer Institute with the tools it needs to develop the early diagnostic methods and treatments that are currently lacking for pancreatic cancer patients."

About the Pancreatic Cancer Action Network

The Pancreatic Cancer Action Network is the only national organization creating hope in a comprehensive way through research, patient support, community outreach and advocacy for a cure. The organization raises money for direct private funding of research--and advocates for more aggressive federal research funding of medical breakthroughs in prevention, diagnosis and treatment of pancreatic cancer.

The Pancreatic Cancer Action Network fills the void of information and options by giving patients and caregivers reliable, personalized information they need to make informed decisions. We create a sense of hope and community so no one has to face pancreatic cancer alone. The organization helps support individuals and communities all across the country work together to raise awareness and funds to find a cure for pancreatic cancer.

Pancreatic Cancer Action Network
http://www.pancan.org

Labels: Cancer, pancreatitis

We've all gotten them at one time or another: gifts of food that were disappointing or misguided, even comical. Sometimes it isn't the gift itself that doesn't work so much as the match between the gift and the recipient.

For example, I was the goofball who, with all the best of intentions, gave a Starbucks gift card to a music teacher at my daughter's school. It didn't occur to me that he might be a Mormon (see No. 7 in the list below).

Here's another example: I was once given dark chocolate as a gift, when anyone who knows me well knows that I prefer milk chocolate. (The giver in this instance happened to be my mother.)

So, with some personal experience and some tongue-in-cheek reflections on gifts from Christmases past, here is my list of 13 food gifts NOT to give:

1. Don't give sugar-free candies or chocolates to someone with IBS (irritable bowel syndrome) or other intestinal issues. The sugar replacement often used in these products is maltitol, which is only partially digested and absorbed. The part that isn't digested tends to ferment in the intestinal tract and attract water. To someone with diarrhea -predominant IBS, having a few pieces of these sugar-free goodies can cause some "intestinal issues". (As someone who has IBS, I can speak from sad experience.) We'll leave it at that.
2. Pay attention that you don't give tea with special properties to someone whom it might offend. The Republic of Tea, for example, makes "Get Lost" tea, described as "herb tea for weight control"; "Get it Going" tea (for regularity); and "Get Gorgeous" tea (for clear skin).
3. Be sure you don't give alcohol to someone who doesn't (or shouldn't) drink. Even if someone has consumed alcohol in the past, they may now be avoiding it for a number of possible reasons.
4. Don't give those tins of stale popcorn to pretty much anyone. If it isn't fresh, it isn't worth the calories.
5. Don't give fruitcake as a food gift, because all the fruitcake jokes known to man are bound to ensue moments after it is unwrapped.
6. Don't give a gift assortment of dark chocolates to someone who is passionate about milk chocolate (or vice versa). The same goes for giving cream-filled chocolates to someone who is wild about nuts and chews.
7. Don't give alcohol or anything with caffeine to a member of the Church of Jesus Christ of Latter-Day Saints. These items are not in line with their beliefs.
8. If you don't know the gift recipient all that well, avoid holiday processed meat gift packs (from gourmet catalogue companies) or other foods containing meat, in case your giftee is a vegetarian.
9. Don't give food gifts that include chocolate, peppermint or spearmint, garlic and onions, coffee, caffeinated tea, citrus, tomato products, or chili peppers, to someone who suffers from acid reflux.
10. Don't give any food containing pork or pork products, or that combines dairy with meat products, to someone who keeps kosher or observes Muslim dietary laws.
11. Don't give peanut brittle, caramel apples, or candy canes to people with braces. According to H. Dixon Taylor, DDS, an orthodontist in Concord, Calif., these are the three worst food gifts for someone with orthodontics. (And about 20% of Taylor's clients happen to be grown-ups.)
12. To that friend of yours who is working hard to lose extra pounds, don't give a gift card to The Cheesecake Factory.
13. Don't give chocolate-covered insects to people who might be "bugged" by it. I'm serious -- this actually happened to an acquaintance's mom, and she was definitely not amused!

source WebMD

Labels: acid reflux, IBS, Irritable Bowel Syndrome

Researchers at the University of Pennsylvania School of Medicine have discovered stem cells in the esophagus of mice that were able to grow into tissue-like structures and when placed into immune-deficient mice were able to form parts of an esophagus lining. The investigators report their findings online this month in the Journal of Clinical Investigation.

"The immediate implication is that we'll have a better understanding of the role of these stem cells in normal biology, as well as in regenerative and cancer biology," says senior author Anil K. Rustgi, MD, the T. Grier Miller Professor of Medicine and Genetics and Chief of Gastroenterology. "Down the road, we will develop a panel of markers that will define these stem cells and use them in replacement therapy for diseases like gastroesophogeal reflux disease [GERD] and also to understand Barrett's esophagus, a precursor to esophageal adenocarcinoma and how to reverse that before it becomes cancer."

Diseases of the esophagus are very common in the United States and worldwide. "Benign forms include GERD and millions are affected," notes Rustgi.

GERD can sometimes lead to inflammation of the esophagus, called esophagitis. "In some of these cases esophagitis can lead to a swapping of the normal lining of the esophagus with a lining that looks more like the intestinal lining and that's called Barrett's esophagus," explains Rustgi. "This can lead to cancer of the esophagus, which is the fastest rising cancer in the US, increasing by 7 to 8 percent a year."

The researchers set out to identify and characterize potential stem cells--those with the ability to self renew--in the esophagus to understand normal biology and how injured cells may one day be repaired.

First, they grew mouse esophageal cells they suspected were adult stem cells. Those cells formed colonies that self renewed. These cells then grew into esophageal lining tissue in a three-dimensional culture apparatus. "These tissue culture cells formed a mature epithelium sitting on top of the matrix," says Rustgi. "The whole construct is a form of tissue engineering."

The investigators then tested their pieces of esophageal lining in whole animals. When the tissue-engineered patches were transplanted under the skin of immunodeficient mice, the cells formed epithelial structures. Additionally, in a mouse model of injury of the esophagus in a normal mouse, which mimics what happens during acid reflux, green-stained stem cells migrated to the injured lining cells and co-labeled with the repaired cells, indicating involvement of the stem cells in tissue repair and regeneration.

Eventually the researchers will develop genetically engineered mouse models to be able to track molecular markers of esophageal stem cells found in a micorarray study. The group has already developed a library of human esophageal cell lines and is looking for human versions of markers already identified in mice.

"The ultimate goal is to identify esophageal stem cells in a patient, grow the patient's own stem cells, and inject them locally to replace diseased tissue with normal lining," says Rustgi.

Penn co-authors are Jiri Kalabis, Kenji Oyama, Takaomi Okawa, Hiroshi Nakagawa, Carmen Z. Michaylira, Douglas B. Stairs, and J. Alan Diehl (Department of Cancer Biology), as well as Jose-Luiz Figueiredo and Umar Mahmood from Massachusetts General Hospital, Molecular Center for Imaging Research, Boston, and Meenhard Herlyn, from The Wistar Institute, Philadelphia.

This work was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute.

This release and a related image can be found at: http://www.uphs.upenn.edu/news/News_Releases/2008/12/esophagus-tissue-growth.html

PENN Medicine is a $3.6 billion enterprise dedicated to the related missions of medical education, biomedical research, and excellence in patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.

Penn's School of Medicine is currently ranked #4 in the nation in U.S.News & World Report's survey of top research-oriented medical schools; and, according to most recent data from the National Institutes of Health, received over $379 million in NIH research funds in the 2006 fiscal year. Supporting 1,700 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

The University of Pennsylvania Health System (UPHS) includes its flagship hospital, the Hospital of the University of Pennsylvania, rated one of the nation's top ten "Honor Roll" hospitals by U.S.News & World Report; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center. In addition UPHS includes a primary-care provider network; a faculty practice plan; home care, hospice, and nursing home; three multispecialty satellite facilities; as well as the Penn Medicine at Rittenhouse campus, which offers comprehensive inpatient rehabilitation facilities and outpatient services in multiple specialties.

University of Pennsylvania School of Medicine
3535 Market St., Mezzanine
Philadelphia
PA 19104
United States
http:// www.med.upenn.edu

Labels: acid reflux, esophagus

Although irritable bowel syndrome (IBS) is the most common disease diagnosed by gastroenterologists, it's also one of the most misunderstood. That's why updated guidelines addressing the management of the condition are being released by the American College of Gastroenterology.

Through a comprehensive review of the latest medical research and expert consensus, the updated guidelines provide clinicians with a comprehensive and practical set of recommendations for the diagnosis and treatment of IBS.

"The last time the American College of Gastroenterology published guidelines for the management of IBS was in 2002, and the College recognized that in the span of five to six years there has been a remarkable explosion in knowledge that's become available that's helped us to understand the cause and management of IBS," says William Chey, M.D., professor of medicine and director of the Gastrointestinal Physiology Laboratory at the University of Michigan Health System.

Along with Philip Schoenfeld, M.D., also of the U-M Division of Gastroenterology, Chey has helped to develop the new evidence-based recommendations.

IBS is a chronic disorder of the lower intestine that causes cramping, abdominal pain, bloating, constipation and/or diarrhea that affects 10 to 15 percent of the U.S. population. The new recommendations show that "there really are things to do for these patients; it's not a hopeless situation," says Chey.

Some of the most significant evidence-based recommendations from the guideline include:

-- Most patients with typical IBS symptoms and no alarm features such as bleeding, weight loss, or a family history of colon cancer, inflammatory bowel disease or celiac sprue, do not need extensive diagnostic testing before confidently diagnosing IBS.

-- IBS patients with diarrhea or a mixture of diarrhea and constipation should be screened with blood tests for celiac disease, a condition in which one cannot tolerate the gluten protein found in wheat and other grains.

-- When patients with IBS and diarrhea undergo colonoscopy, biopsies should be obtained to rule out a rare disease called microscopic colitis.

-- The use of anti-depressants, tricyclic agents and selective serotonin reuptake inhibitors, can be helpful for some patients with IBS.

"There is a stronger recommendation that tricyclic antidepressants, used in low doses before people go to sleep at night, are an effective medicine for irritable bowel syndrome," says Schoenfeld, associate professor of internal medicine at the U-M Medical School. The agents in these antidepressants can reduce bloating and discomfort by altering brain-gut signaling about motility and distention. He adds that constipation, a side effect of tricyclic antidepressants, is actually beneficial to many people in this population.

-- The drug lubiprostone, a chloride channel activator, benefits a subset of women with IBS and constipation.

-- Evidence suggests that a specific probiotic called Bifidobacter infantis offers benefit to some patients with IBS and diarrhea.

-- The non-absorbable antibiotic called rifaximin has been found to be of benefit for selected patients with IBS, in particular those with bloating and diarrhea.

-- For women with more severe IBS and diarrhea who have not responded to standard therapies, alosetron, a drug which alters an important neurotransmitter called serotonin, can be considered.

IBS usually begins in young adulthood, and women are twice as likely as men to be diagnosed with IBS in the United States. Despite intensive research, the precise cause of IBS is not clear. Suggested contributors to IBS include abnormal contractile activity of the intestines and colon, altered sensation within the gastrointestinal tract, exaggerated reactions to stress or anxiety, and/or problems arising from the interaction between the bacteria and immune system within the intestines and colon.

Treatments are often combined to reduce the pain and bowel-related symptoms of IBS, and it may be necessary to try more than one combination to find the one that is most helpful, Chey and Schoenfeld note.

Before newer therapies and medications were available, much of the effort to treat IBS symptoms focused on lifestyle, diet and reduction of stress. Some dietary changes that many patients have found helpful:

-- Avoid or limit the amount of gas-producing foods such as beans, onions, broccoli, cabbage or any other foods that will commonly aggravate IBS symptoms.

-- Try to slow down when you eat and avoid overeating.

-- Avoid carbonated drinks. These can introduce gas into the intestines and cause bloating or abdominal discomfort.

-- Intolerance to milk sugar, or lactose, is seen in up to 40 percent of patients with IBS. Avoiding dairy products may be helpful in reducing symptoms of IBS such as gas, bloating, cramping and diarrhea.

-- Avoid large quantities of other sugars such as fructose or sorbitol which can also worsen IBS symptoms

-- The addition of fiber in the form of psyllium can help with constipation related symptoms in IBS patients.

A structured, focused diagnostic evaluation will lead to a confident diagnosis of IBS says Chey. There are some good treatment options for people diagnosed with IBS. With effective counseling, dietary and lifestyle intervention, and use of over-the-counter and/or prescription medications, IBS can be effectively managed in the vast majority of patients, Chey notes.

For a full list of the IBS guidelines please visit http://www.nature.com/ajg/journal/v104/n1s/index.html.

University of Michigan Health System
http://www.med.umich.edu

Labels: IBS, Irritable Bowel Syndrome

Scientists have uncovered vital clues about how to treat serious bowel disorders by studying the behaviour of cells in the colon.

Researchers at the University of Edinburgh believe a chemical messenger that is essential for developing a baby's gut in the womb could hold the key to new treatments for inflammatory bowel disease (IBD), a condition which affects 1 in 250 people in the UK.

The team studied a chain of chemical reactions inside colon cells, called the Hedgehog signalling pathway, which controls the way it behaves and communicates with other cells.

The researchers found that some patients with IBD inherit a defective copy of one of the important links in this chain, a gene called GLI1. This defective GLI1 is only half as active as normal. Additionally, the Hedgehog pathway itself signals at lower levels than normal when the large bowel is inflamed.

The results suggest that the GLI1 protein may calm inflammation within the healthy colon, and that this process appears to go wrong in IBD patients, causing their gut to become inflamed.

The researchers now hope to test whether strengthening this weakened protein will help to prevent or treat inflammatory bowel diseases like Crohn's disease and ulcerative colitis.

Dr Charlie Lees from the University's Institute of Genetics and Molecular Medicine, who led the study, said: "Everybody has billions of bacteria in the gut, the vast majority of which do us no harm. Our body's natural immune responses identify and eliminate harmful bacteria, whilst living in harmony with the healthy bacteria. But in people with inflammatory bowel disease, that response goes wrong and an over-active immune response against these healthy bacteria leads to chronic inflammation in the gut.

"It now seems that the Hedgehog signalling pathway, and specifically the GLI1 protein, is crucial to that response. We think it provides an important signal to certain types of immune cells in the gut wall, instructing them to adopt an anti-inflammatory state. If we can find ways to bolster these responses in people with IBD, we may be able to help prevent the painful attacks which are so devastating to patients."

Labels: IBD, Inflamatory Bowel Disorders