ICN Feature Column - FRESH TASTES by Bev Laumann

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You Are Here: IC Network : Fresh Tastes : September 2003

Help for Painful Gas and Bloating

Stomach AcheThe unpleasant sensations of abdominal gas and bloating are a minor but common human misery that everybody gets now and then. Just check how many feet of shelf space at the drugstore are taken up with "anti-gas" remedies. But for some people, intestinal gas can be not only uncomfortable and embarrassing, it can be downright excruciating. And what's worse for people with IC, intestinal trouble may provoke our sensitive bladder.

Relieving the trouble starts with figuring out what's at the root of the situation, but of course like so many things relating to IC, that's easier said than done. It's yet another situation where "each person is a bit different" and one approach doesn't fit all. Happily however, once we've identified the cause, relief is often surprisingly easy to come by. Doctors know that unlike pain in an arm or leg, visceral abdominal pain is often hard for patients to pinpoint. It may seem to spread from one area to another or be "all over" the whole pelvic area. What's even more confusing for patients, pelvic pain can be "referred" from one site to another. For instance, sometimes IC patients feel bladder flare-ups as an ache in their lower back-- an excellent example of how pain is "referred" from one area of the pelvis to another. Once we've had IC for awhile though, we get to know our body well and can ace out when the culprit is our bladder, and when it isn't.

IBS - A Common Complaint of IC patients

When painful gas and bloating becomes more of a daily burden than an occasional annoyance, it's time for a trip to the doctor to rule out serious illness. The trouble can stem from a variety of causes. Yet for most of us, the cause is not life-threatening. Perhaps one third or more of all IC patients exhibit such gastrointestinal symptoms as part of an IC-associated disorder called irritable bowel syndrome (IBS). IBS is commonly diagnosed with a procedure known as a colonoscopy. This is similar to a cystoscopy, used to diagnose IC. For a colonoscopy, the doctor looks into the colon through a flexible tube and views the lining, looking for signs of possible disease.

IBS is a functional gastrointestinal disorder. That means the colon looks perfectly normal but it functions abnormally. IBS is a disorder of increased colon sensitivity, much as IC involves an increased sensitivity of the bladder. And, like both allergies and IC, it involves a type of cell known as a mast cell.

In IBS, the colon is so unusually sensitive that it may over-react to even the gentle stimulation of a little gas. The reaction may take the form of painful violent spasms of the colon's smooth muscle. That's why some doctors also refer to the condition as "spastic colon." IBS is a disorder involving a variety of symptoms, and like IC, not everyone has exactly the same severity or pattern of symptoms. Along with abdominal cramping and pain, IBS can also include chronic diarrhea, chronic constipation, or alternating bouts of each.

Once the doctor has diagnosed IBS, he may recommend dietary changes and offer medications to calm the bowel spasms. Some of the medications that are useful for IC are also useful in controlling IBS. Antispasmodics such as Levsin may be prescribed to calm the colon spasms. Tricyclic antidepressants such as Elavil, Sinequan or Tofranil, may be prescribed to relieve pain and reduce the colon's sensitivity.

IBS usually responds well to dietary modification too. In general, there are several
dietary guidelines that doctors recommend, some of which are already familiar to people with IC:

  1. Avoid alcohol and caffeine
  2. Avoid the food additives fructose and sorbitol, particularly if they occur together.
  3. Minimize the intake of foods high in saturated fats (i.e., ham, bacon).
  4. Minimize the intake of "hot" spices (i.e., chili pepper, paprika, cloves).

Some people with IBS suffer from chronic constipation too. And quite a few of the
medications we take for IC merely add to that problem. Here are some of the chief offenders:

  1. Smooth muscle relaxants and antispasmodics (Ditropan, Levsin, Detrol)
  2. Antihistamines and drugs with antihistamine properties (Atarax, Vistaril, Benedryl, Allegra, Claritin, etc.).
  3. Some pain killers (Vicodin, Ultram, Oxycontin, etc.)
  4. Large amounts of calcium-containing antacids (Tums, Prelief, etc.)

Unfortunately, some foods IC people can safely eat bladder-wise, are constipating and definitely not helpful for constipation-predominant IBS. Rice and pasta are two foods that fall into that category. On the flip side, there is diarrhea-predominant IBS. The medications and foods that make the constipation worse, may tend to help the diarrhea-predominant type. But there are some bladder-friendly foods that people with diarrhea-predominant IBS will have trouble with because they tend to have a laxative effect: peas, lentils, beans, and large amounts of high-fiber foods. (High fiber foods include pears, whole wheat bread, and most vegetables). The starch in potatoes can also have somewhat of a laxative effect.

While fighting bladder flares with antacids, beware of using baking soda in water if you have the diarrhea-predominant version of IBS. It may make the diarrhea worse (though the strategy may be helpful to people with constipation-predominant IBS).

Food allergies can trigger gas

Two other common conditions besides IBS can also provoke intestinal gas, pain, and bloating: food allergy and food intolerance. A significant proportion of IC patients suffer from allergies and intolerances, and allergic IC patients often find relief from bladder symptoms when they avoid the foods they are allergic to. But while the intestinal symptoms may be similar, a food allergy is not the same as a food intolerance. A true allergy is mediated by a substance in the body called IgE. In diagnosing an allergy, a doctor may look for high levels of circulating IgE in your system. An intolerance does not involve IgE. Another difference: allergies are usually triggered by proteins in foods (and sometimes proteins in the additives derived from those foods), whereas intolerances can develop in reaction to sugars, gluten, and many other non-protein molecules.

Often, if a food allergy is the culprit in abdominal symptoms, it may also manifest itself as IC bladder symptoms. This may be because allergies typically involve a release of the mast cell irritant, histamine. Mast cell troubles figure prominently is such diverse conditions as interstitial cystitis, migraines, IBS, and allergies. Do you also have any itchiness that mysteriously comes and goes?... sneezing after dinner?... a runny nose when you eat? These can be triggered by histamine and may be clues that a food allergy is at work. And don't rule out a "food packaging allergy." BHA and BHT are two widely used preservatives that keep critters from eating their way through both food and food containers. The preservative is often applied to the packaging, not the food. But a small amount of these chemicals do get into the food anyway and, according to allergists, may trigger an allergic reaction. For food allergies, avoidance is the best solution, but oral and topical antihistamines may help the symptoms.

Lactose intolerance a common problem

Most people have heard of lactose intolerance, but it's quite possible to have an intolerance to other food substances too. An intolerance simply means your body can't handle the substance... for whatever reason. Sometimes the body may lack a crucial enzyme or other substance needed to process the food. Sometimes the ultimate cause is genetic. Your doctor may be able to identify why your intolerance occurs, or he may not. Millions of people in the U.S. have intolerances to certain foods, and for many, the cause remains a mystery.

Over the years I've spoken with dozens of IC patients who suffer from lactose intolerance. Symptoms involve abdominal cramps, gas, (and possibly diarrhea) experienced after eating dairy products. Lactose intolerance is an inability to digest a sugar found in milk (lactose), because the body fails to produce an enzyme (lactase), necessary to break it down. If the lactose isn't broken down, the body can't utilize it and the sugar continues through the intestines intact.

Eventually it arrives at the colon where bacteria have a feast on the sugar, producing copious quantities of gas as a by-product. An over-the-counter lactase enzyme product (Lactaid, for example) can be helpful when taken with dairy products. It's well known that people of Asian, Middle Eastern, or African heritage are more likely to have a lactose intolerance, but that doesn't mean it occurs exclusively in those groups.

Suzanne, a fair-skinned blond of northern European heritage who was a life-long milk drinker, was recently surprised to find dairy products now give her gas, cramps, and painful bloating. As long as she avoids dairy or takes Lactaid, she does fine. Now in her late twenties, her only previous gastrointestinal problems were colic during her first few months of life. She speculates that perhaps her body's ability to produce lactase has varied throughout her life-- sometimes normal, and sometimes not. A recent convert to vegetarianism, and also a busy mother of two preschoolers, she also wonders if fluctuating lactase levels are her body's response to dietary change, ongoing stress, and lack of sleep.

Doctors now suspect that an undiagnosed lactose intolerance may be at the root of some people's IBS, or at least exacerbate it. But here's another surprise: don't assume that, because you've been drinking milk all your life with no problems, the IBS you've recently developed has nothing to do with lactose intolerance. Gastroenterology specialist Jarol Knowles, MD, of the University of North Carolina noted that studies have confirmed lactose digestion problems in some IBS patients who are unaware of any symptoms related to eating dairy products. He noted in one article, "...hydrogen breath tests were performed on patients who had been diagnosed with IBS but who had no apparent symptoms related to the ingestion of milk. Lactose malabsorption was diagnosed in 68% of these patients. Symptoms improved after a lactose restricted diet was introduced." Lactose intolerance can be diagnosed with a hydrogen breath test, a test he now recommends for all of his IBS patients.[1]

Fructose malabsorption: it's more than just a fruit problem

In the last few years another food-related intolerance has come to light as a possible cause for many people's gas, bloating and abdominal pain. Once thought of as severe, rare, and the result of a genetic disorder, mild to moderate fructose intolerance is now suspected to occur in a significant proportion of the healthy population as well as play a part in some cases of IBS.

Fructose is a sugar found in fruit. Sucrose (regular table sugar) is made up of glucose and fructose. Sugars can be big complex molecules, or small and simple ones. The simplest sugar is glucose, which is the sugar our bodies use for energy. Before any kind of sugar we eat is utilized it must be broken down into small, simple units. But some of us apparently have trouble breaking down and utilizing fructose. And, as with lactose intolerance, when fructose is allowed to pass through the digestive tract to the colon, bacteria have a field day producing gas.

In a study presented in 2002 to the 67th Annual Scientific Meeting of the American College of Gastroenterology, researchers at the University of Kansas indicated that fructose may not be properly absorbed by a significant portion of healthy adults. Subjects in their study were given levels of fructose about equal to that in a typical can of soda. They were then given a hydrogen breath test (excess hydrogen gas would be present if the fructose the person couldn't digest was instead being utilized by gut bacteria). The study showed nearly half the subjects had abnormally high levels of hydrogen gas.

In another paper presented in 2001 to the College of Gastroenterology's Annual Scientific Meeting, Young Choi, MD, and colleagues at the University of Iowa studied 219 people with unexplained abdominal pain, gas and bloating. In 78 percent of subjects, breath tests revealed abnormal levels of hydrogen or methane gas in response to ingesting fructose. The fructose actually provoked symptoms in 58 percent.

And in an article appearing in August 2000, sugar malabsorption was linked to cases of irritable bowel syndrome (IBS). In that study of 239 patients with IBS, only 7 percent had normal absorption of three sugars commonly found in food (fructose, lactose and sorbitol).The patients showed a 56 percent improvement in symptoms after restricting their intake of the sugars for one month. [2]

Fructose in the American diet is increasing, and not because we are eating more fruit. Manufacturers are adding ever-increasing amounts of sugars of all kinds to food. And high fructose corn syrup is substituting for other sugars in processed foods because it is cheaper.

So what foods have fructose? All fruits of course, and processed foods that state fructose, high fructose corn syrup, or sucrose on the label are the obvious culprits. But some other foods have varying amounts of fructose and may or may not be bothersome, depending on your level of sensitivity: ham, bacon, lunch meats, sweet potatoes, yams, corn, carrots, peas, yellow squash, sugar-added boxed cereals, mayonnaise, many salad dressings, honey, tomato and tomato juice, maple syrup, carbonated sodas, jellies.

Indigestible sugars the well-known culprits

Certain kinds of sugars are simply not digestible by humans at all. Cellulose for instance, (a constituent of wood) is a sugar that mammals can't digest but termites can. Raffinose, stachyose, and verbascose are three indigestible sugars found in abundance in beans, nuts, legumes such as peanuts, lentils and soy, some grains, and cruciferous vegetables such as cabbage and cauliflower. The embarrassing social effects of eating beans can be attributed to the fact that we can't utilize these sugars but alas, some of the bacteria in our colon can. To avoid pain from a sensitive colon we can avoid these gas-producing foods of course, but what IC patient wants to extend their already long list of things to avoid?

Helpful products

For gas pains provoked by beans and such, there's another solution: Beano. Beano is an enzyme product available at most drug stores and some supermarkets. You take it when you eat the offending food. It supplies your body with the enzyme needed to break indigestible sugars like raffinose into their more digestible components: glucose, sucrose, galactose and fructose. One word of warning though be sure to take your Elmiron at least an hour before, or two hours after, a meal with Beano. Beano, when taken close to a dose of Elmiron, does appear to dampen its pain-reducing effect.

Another product that might be worth a try is Algonot. I've had IBS for a number of years, and after I took Gastrocrom ( a prescription medication) a few years ago, the IBS calmed down and the symptoms eventually disappeared. But after a stressful summer this year, the IBS symptoms returned with a vengeance-- cramping, gas, constipation. So, this time rather than doing the Gastrocrom again, I tried adding Algonot to my regular pill regimen. Algonot is a dietary supplement that contains the mast-cell stabilizer and anti-inflammatory, quercetin. I have a sensitive stomach so I started with only one capsule a day and worked up to the recommended dosage. (The manufacturer also advises chilling the capsules in the fridge or freezer to help with any initial stomach upset. That worked like a charm!) My stomach upset disappeared in a few days and I could then take one a day at room temperature. (This reaction is also typical of Gastrocrom it may make things worse a bit before making it better). The Algonot didn't initially reduce the intestinal gas-- I still had a lot of "rumbling"; but apparently my colon's sensitivity to the gas was reduced within about three weeks. It could rumble away with no cramping! After two months on Algonot, the gas issue has "passed" (excuse the pun!). I now have little intestinal rumbling, no constipation, and best of all no IBS pain. I feel like my IBS is now nicely under control again.... and in about ten months less time than the Gastrocrom took to give me the same level of relief.

Like so many things with IC, everyone's different. It may or may not work for you. To my knowledge, there has been no published, large-scale, controlled, clinical trial of Algonot (or its specific ingredient combination) for irritable bowel syndrome. It is pricey-- about a hundred dollars for a ninety-day supply. The product also contains chondroitin and glucosamine, substances the manufacturer says may help IC symptoms, too. Medical journals in recent years have been filled with generally hopeful articles on these two substances as treatments for osteoarthritis and other auto- immune disorders. And I understand there is a study of Algonot (for IC), in the works.

Your doctor may prefer to prescribe Gastrocrom (cromolyn sodium), also a mast cell stabilizer, for your IBS. There is some published evidence in the literature for Gastrocrom's use for IBS, though it is mainly used for another mast-cell related disorder, systemic mastocytosis. It comes in vials that you squirt into a glass of water and drink half-an- hour before meals. It has to be taken over a long period of time to be truly effective, though. You or your doctor can get more information on Gastrocrom at the manufacturer's web site: www.celltechgroup.com.
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References:
1. Jarol B. Knowles, M.D. Dietary factors in gastrointestinal diseases. 1998. Participate, Vol. 7, #3, pgs. 1-3., publ. by International Foundation for Functional Gastrointestinal Disorders (IFFGD).
2. Goldstein R., et al. Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. 2000. Israeli Medical Association Journal, Vol 2, #8; pgs 583-587.


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