Colitis and nutrition: the strange mix between gluten and fermented products

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10560681_mColitis and irritable bowel syndrome, for many years considered and treated almost exclusively as an expression of stress and neurosis, are now widely recognized for their inflammatory causes.

Food and its related inflammation are among the most frequent causes, often accompanied by a significant imbalance in the intestinal flora.

In a few words, one of the major reasons that leads to a GP consultation (12% of all visits) or to visit a specialized gastroenterologist (28% of all visits, at least in Europe) is due to colon irritation and its downstream effects, such as swelling, pain, flatulence, indigestion, heartburn, diarrhoea or constipation and intestinal malabsorption phenomena.

The connection with food has been described also for the case of much more critical conditions, such as Crohn’s disease and ulcerative colitis, as well as all the inflammatory bowel diseases (IBDs), which is a subject of particular interest to our staff, who carefully follows all the scientific news in this direction.

In our practices, we have been following for years several people affected by this type of problems by adopting specific therapeutic courses; the majority of people treated shows a food personal profile, often correlated with reactivity to gluten or fermented products (i.e. yeasts), or even a combination of the two.

The relevance of gluten in determining this type of response has been the subject of extensive discussions, especially because for various years – at least until 2009 – the possibility that gluten and wheat could represent a potential source of illness or disease had been extensively opposed by those industries producing wheat derivatives (bread and pasta above all), and by those who manage medical communications and celiac disease-linked trading organizations.

For years, any event of non-celiac disease intolerance to wheat was deemed simply as “non-existent”, despite the amount of scientific work produced in this regard. The only possible reactions to wheat and gluten could be either the IgE-mediated allergy (rare and potentially serious) or the celiac disease.

Today, however, we know with certainty that a Non-Celiac Gluten Sensitivity (NCGS) does exist, potentially involving 30% of the so-called healthy population.

In the last few years, a peculiar dietary regime restricting certain aliments, able to ferment in the intestine, has gained a significant appeal in an effort to defend gluten.

This diet removes the so-called FODMAP (aka Fermentable, Oligo, Di, Monosaccharides and Polyols), that is, it attempts to reduce or eliminate from the diet those aliments able to undergo fermentation, such as some sugars (for example fructans, which are contained in wheat, or fructose, lactose and galactans, as well as the biggest part of artificial sweeteners).

A study published on the journal Gastroenterology confirmed that a diet of this type may significantly reduce the irritable bowel symptoms (EP Halmos et al, Gastroenterology. 2014 Jan; 146 (1):67-75.e5. Doi: 10.1053/j.gastro.2013.09.046. Epub 2013 Sep 25), thus providing, once again, solid indications on how to treat such a condition in a way practical and feasible to anyone, instead of following those treatments classically prescribed (drugs, bowel relaxants, monthly cycles of antibiotics), which do not hit the problem at its roots.

So we do have a proved fact. The majority of cases of irritable bowel syndrome or colitis are to be approached with a correct diet.

However, it is interesting to observe that the anti-FODMAP diet (here a link to find an in-depth analysis from Stanford University) helps to keep under control a number of substances, including all those containing gluten, in addition to those fermented, by considering in the group also those containing those types of sugar that can cause fermentation (practically all!).

Therefore, choosing to keep gluten and fermented substances under control (along with lactose) appears as the right choice to control such disorders.

Years of experience has led us to ensure that our patients, once they identified their personal nutritional profile (obtained through a food-related inflammation test), may have periods of attentive control of their nutrition alternated with moments of freedom.

The chance of having an active social life (with wide periods of “food freedom”) along with a well-balanced control plan, allows everyone to keep such condition under control, in a balanced, satisfactory way.

Still, we should discuss the relevance of such a generalized diet, which has been proposed as necessarily good for everyone (as the example of the anti-FODMAP regime), to treat certain conditions, such as the irritable bowel syndrome, which show features so individualized, to have led the disease to be mistaken for a psychological disorder.

We do believe that each person should be let free to evaluate her/his individual nutritional profile and decide what to eat. Indeed, we transfer such approach to our daily clinical practice.

Instead, we are deeply against the hypothesis that finds only in fructans (or other specific sugars) the responsible molecules for colitis. Scientific investigation is extremely relevant and more precise identification of the mechanisms of a disorder may help in understanding. At the end, however, the end-user will always have to control gluten and gluten-containing grains.

If any scientific groups prefer to say that these conditions are not a direct reaction to gluten, but instead one to the fructans contained into gluten-containing grains, we will accept this definition. In practice, those who want to heal from this type of cholitis will always have to keep those grains under control, in the same way that a gluten-free diet would require to do.

We prefer to talk of a temporary control of individual reactivity, and to offer a way to heal towards food tolerance and the possibility to go back to eating anything with pleasure, as we have been doing for many years.