We all are interested in the role diet may play in causing a disorder. But clear-cut and established cases are few, but striking, in their importance. If a newborn baby lacks the proper enzyme systems, then it will develop the disease called phenylketonuria if the diet contains any phenylketones. If an individual’s intestines are defective and contain no lactose the enzyme that digests lactose, the sugar of milk the person will be unable to digest milk or milk products.
If an individual is born with or develops the disorder known as gluten enteropathy, then he or she will be unable to digest any gluten in the diet (from wheat, rye, oats, or perhaps barley). If the ileum is diseased, disordered, or removed surgically, then that would lead to trouble in absorbing vitamin B12, some forms of fat, and lead to an increase in oxalate in the urine, which leads to kidney stones. These illustrative cases seem fairly straightforward.
Another group of problems arises if the diet is deficient in certain substances. Vitamin C cannot be synthesized by the human organism, and if the diet is deficient in C, the patient develops scurvy, even in the twentieth century or the twenty-first.
But consider this situation: Cancer of the colon is seen less frequently in individuals whose diets are rich in fruits and vegetables, but we do not know what ,this diet contains that protects the patient, Recent studies have singled out the vitamin content (beta-carotene, the precursor of vitamin A) and antioxidants such as vitamins C or E. But the possibility may exist that these people eating less vegetables and fruit are eating more of other substances which might be harmful to the colon. We just don’t have all the facts yet.
And there are the problems that arise in the area of treating intestinal conditions. What do we need to add to the diet to treat constipation and diverticulosis usually bran and fiber. What substances in the diet should we do without? All fruits and vegetables in the case of diarrhea disorders. What substance do we add to the diet in the presence of anemia? What diet do we use in gluten malabsorption, or for hyperoxaluria and kidney stones due to increased oxalate in the urine?
This part of the article will describe what we do know about the role of food in the health of the GI tract. We start with ulcers, move to the gallbladder and pancreas, describe the dietary approach to malabsorption, food allergies and intolerance’s. We cannot avoid discussing the ubiquitous irritable bowel syndrome, constipation, and diarrhea. Then we enter the colon with its diverticula and diverticulitis, the inflammatory bowel diseases (Crohn’s and ulcerative colitis), as well as cancer of the colon and its forerunners.
Let’s start with the upper intestinal tract and consider its inflammatory and ulcerative disorders: heartburn and peptic esophagitis, gastric and duodenal ulcer, and gastritis. I begin here not only because the problems originate in the first portion of the gastrointestinal tract, but because they probably represent the largest group of disorders from which we suffer.
Heartburn and Peptic Esophagitis Acid in the Gullet:
Heartburn is that annoying, uncomfortable, burning discomfort just behind the breastbone, which may also reach up as high as the back of the throat. Closely aligned to it is the discomfort and the pain of esophagitis, also felt along the same route. In both complaints, individuals experience reflux of stomach contents and acid into the lower portion of the esophagus, which have gotten past the esophageal sphincter muscles of the lower swallowing tube the guardians and gatekeepers that prevent the lower section of the esophagus from being invaded by these irritants. We will experience heartburn when acid gets into the esophagus and will develop esophagitis if this reflux occurs often enough to result in inflammation, and even at times ulceration, of the esophageal lining walls.
Why the sphincters let down their guard still remains an incompletely resolved problem. We used to put all the blame on a hiatal hernia in this area, but the mere presence of a hernia does not explain the periodic relaxation of the lower esophageal sphincter muscles. It is the presence of the acid that causes the mischief, but one does not need a large amount of acid, just a small amount will do. Indeed, those of us who have heartburn or esophagitis are not necessarily making larger quantities of acid than others free of the disorder and we are not over-secretors.
With reflux, our dietary habits and customary food intake can make a difference. Obviously, making less acid would help, but of equal importance, the acid must exit from the stomach promptly by the regular emptying machinery. We must arrange somehow to have as little acid as possible remaining in the stomach to be refluxed into the esophagus to solve this problem.
Let us consider first how we eat or should eat with this condition before we discuss what we should eat. In addition to the chemistry of our food, the size of the meal plays a crucial part in these conditions. The cells of the stomach lining are stimulated to pour forth the acid they manufacture hydrochloric acid when the stomach is distended and the walls stretched. So the larger the bulk of food eaten, the more likely the stomach is to be stretched taut. Given this machinery, we need to balance the volume of food eaten more evenly between our three customary meals. It makes little sense to have a scanty breakfast, gulp down a hasty sandwich at lunch, and fill the stomach at dinner with a terribly large amount of food.
When we are in the upright position during the day, the stomach regularly empties its contents into the upper intestine through its lower end, the pyloric canal. The typical meal of mixed food contents requires about three hours to be moved completely out of the stomach, taking ninety minutes for the first half from the stomach into the small intestine. Ordinarily, as we eat sitting up, very little gets back into the esophagus by reflux.
The liquid contents of the stomach cannot flow uphill. However, if we lie down, the food in the stomach of a partially digested meal may move backward into the esophagus. The best advice I can give is not to lie down or go to sleep with a, full stomach shortly after eating a meal. Furthermore, if we fill the stomach with carbonated beverages, they release their dissolved carbon dioxide and further distend the stomach. Seeking an exit from the stomach and rising to the higher part of the stomach, the cardia, these beverages release this gas into the esophagus. A belch is simply the reflux of gas or air from the stomach into the swallowing tube.
So far, so good. But what should we put into the stomach if heartburn and esophagitis is the main problem, especially when there is no associated stomach inflammation or ulcer formation to complicate the picture. Obviously, we should not add any acid to our stomach contents. Indeed, most people with this complaint have already discovered that acid citrus fruits should be avoided since they contain ascorbic acid (vitamin C) as well as acetic acid. This list also includes vinegar or salad dressings containing vinegar. In this case, we must take care not to develop the deficiency of vitamin C known as scurvy, but we can get enough vitamin C from fruits and vegetables in our regular diet and a small pill supplement.
Caffeine intake is important for both heartburn sufferers and those with esophagitis, since caffeine is a very strong stimulant of acid (we once used caffeine as a method of stimulating the stomach to test stomach acidity). Caffeine-containing drinks
must be avoided: coffee, tea, cocoa, hot chocolate as well as aver-the-counter headache pills and pills to keep us awake which also contain caffeine. We live in a world filled with caffeine, so it won’t be easy to avoid it entirely. But you must try.
Men and women have enjoyed fermented brews for eons, but we have learned that these beverages stimulate the gastric juices while they lubricate the flow of conversation. Yet, despite these favorable features, alcohol should be avoided with these reflux conditions. Not because it stimulates acid (in fact, alcohol is a rather poor stimulant of gastric juice), but because it irritates tissue that is already inflamed. Why would we pour alcohol over the inflamed tissues of the esophagus? We wouldn’t pour alcohol over a tissue wound anywhere else in the body. For the moderate drinker who enjoys one to two drinks a day, this is not a life sentence. When the esophagus heals and stays healed for a significant amount of time (three to six months), then the restriction can be lifted. However, drinking more than two drinks a day for men and more than one for women is inadvisable for those recovering from reflux conditions, or indeed in any healthy diet.