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Finally a follow-up study on intestinal permeability in celiac disease.
And an IBS study shows that high fiber diets may contribute to adverse
bowel symptoms. One might also consider that the enzyme cellulase needed
to break down the fiber (not produced by the body but obtained from the
very fruits and vegetables which supply the fiber) may be in short supply.
A cellulase enzyme supplement, such as Candex used to treat candida and
other yeast infections which propagate in colon fiber, may help reduce the
gaseous products of fermentation and adverse symptoms caused by excess
fiber.
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Dig Dis Sci. 2005 Apr;50(4):785-90.
Intestinal permeability in long-term follow-up of patients with celiac
disease on a gluten-free diet.
Duerksen DR, Wilhelm-Boyles C, Parry DM.
University of Manitoba, Winnipeg, Manitoba, Canada. [log in to unmask]
Intestinal permeability is frequently abnormal in patients with celiac
disease. The long-term effect of a gluten-free diet on intestinal
permeability and the correlation of intestinal permeability with a gluten-
free diet are not known. The objectives of this study were to determine the
responses of intestinal permeability and antibody testing to gluten free
diet and the degree of correlation of these measurements with gluten
ingestion. In this prospective study, patients with celiac disease were
divided into three groups based on length of time on a gluten-free diet:
Group A, < 1 month; Group B, 1 month-1 year; Group C, > 1 year. Patients in
Groups B and C were tested at baseline and at 4-12 weeks later for the
following: lactulose/mannitol intestinal permeability, endomysial antibody,
and 3-day food record. Permeability tests were also performed in Group A
and control subjects. Intestinal permeability was elevated in newly
diagnosed celiac disease and in individuals on a gluten-free diet for less
than 1 year. Intestinal permeability was normal in 80% at visit 1 and 87%
at visit 2 in individuals with celiac disease on a gluten-free diet for
more than a year. Trace gluten ingestion was associated with increased
intestinal permeability on visit 2 (P = 0.0480). The sensitivity of
detecting gluten ingestion as measured by a 3-day food record was higher
for permeability testing (29 and 36%) compared with endomysial antibody
testing (18 and 18%) for visits 1 and 2, respectively. Intestinal
permeability normalizes in the majority of individuals with celiac disease
on a gluten-free diet. Gluten ingestion as measured by a 3-day food record
correlates with intestinal permeability measurements. The role of
permeability testing in the follow-up of patients with celiac disease
warrants further investigation.
PMID: 15844719 [PubMed - in process]
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Dig Dis Sci. 2005 Apr;50(4):758-66.
Do interventions which reduce colonic bacterial fermentation improve
symptoms of irritable bowel syndrome?
Dear KL, Elia M, Hunter JO.
Department of Gastroenterology, Addenbrooke's Hospital NHS Trust,
Cambridge, UK.
Abnormal fermentation may be an important factor in irritable bowel
syndrome (IBS). Gastroenteritis or antibiotic therapy may damage the
colonic microflora, leading to increased fermentation and the accumulation
of gas. Gas excretion may be measured by whole-body calorimetry but there
has only been one such study on IBS to date. We aimed to assess the
relationship between IBS symptoms and fermentation rates in IBS. A purpose-
built, 1.4-m3, whole-body calorimeter was used to assess excretion of H2
and CH4 in IBS subjects while consuming a standard diet and, again, after
open randomization on either the standard diet together with the antibiotic
metronidazole or a fiber-free diet to reduce fermentation. Metronidazole
significantly reduced the 24-hr excretion of hydrogen (median value
compared to the control group, 397 vs 230 ml/24 hr) and total gas (H2 +
CH4; 671 vs 422 ml/min) and the maximum rate of gas excretion (1.6 vs 0.8
ml/min), as did a no-fiber polymeric diet (hydrogen, 418 vs 176 ml/min;
total gas, 564 vs 205 ml/min; maximum rate of gas excretion, 1.35 vs 0.45
ml/min), with a significant improvement in abdominal symptoms. IBS may be
associated with rapid excretion of gaseous products of fermentation, whose
reduction may improve symptoms.
PMID: 15844715 [PubMed - in process]
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