Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Toileting posture constipation

Wonder what toileting posture implies? Think it is important for good bowel function? While the toileting posture may be non-issue for some, it could be crucial for those with constipation.

Toileting posture is a modifiable factor that can be used as aprt of an overall management strategy.  The use of traditional toilet seats has potential to make recto-anal angle more acute  contributing to difficult passage of stools and constipation. This is particularly an issue in kids who sit with their legs dangling the air as well as the physically challenged subjects who need to use higher chairs in order to be able to get up after defecations. Constipation as kids has potential to persist throughout life. Appropriate toilet posture coupled with abdominal exercises may help in some cases of difficult defecation and constipation.

Regular physical activity, along with appropriate  toileting posture (bending forward), support of the feet while seated on toilet and simple pelvic floor exercises, should be as part of an overall treatment plan for constipation.

Do you or someone you know have constipation? How is your toileting posture? Do you think the issue of toileting posture makes sense? Please share your thoughts.

 

Diverticulitis Prevention

Diverticulitis Prevention - Popcorn, Nuts & Corn

Popcorn, nuts, corn cause diverticulitis. Don't eat nuts, popcorn, corn if you have diverticulosis. Any evidence to support this dietary recommendation in diverticulosis? Does avoiding corn, nuts, popcorn help avoid complications of diverticular disease?

Now we have study looking at the role nuts, popcorn play in diverticular disease. Dr Strate and colleagues from Seatle, WA,  investigated if nut, corn, or popcorn consumption is associated with diverticulitis and diverticular bleeding.

They utilized the Health Professionals Study which is a cohort of US men followed up prospectively from 1986 to 2004 for medical and dietary information. Men reporting newly diagnosed diverticulosis or diverticulitis filled supplemental questionnaires.

They found that in men without known diverticular disease, nut, corn, and popcorn consumption did not increase the risk of diverticulosis or diverticular complication like diverticular bleeding. Surprisingly, there was an inverse association between nut and popcorn consumption and the risk of diverticulitis, i.e. the consumption of nuts and popcorns actually protected against diverticulitis. By the way, probiotics may help in diverticular disease.

Do you or someone you know have diverticulosis? Have you been given dietary advice about nuts, popcorn and corn? Will this article alter your attitude towars intake of nuts, corn and popcorn? Please share your thoughts.

Digestion, upper GI health

Preventative life style measures for healthy digestive system or gut

Patients may be advised to follow some life-style modifications as well care using medications including over-the counter medicines.

• Avoidance of NSAIDs as much as possible should not be restricted to prescription formulations only. For example, NSAIDs in the form of BC powder is taken people in the south for pain on the assumption that it is risk free. candy. Health care providers should try using acetaminophen as much as possible for pain instead of NSAIDs. If NSAIDs are needed, use the lowest possible dose and avoid multiple NSAIDs.
• Smoking increases gastric acidity and affects the gastroprotective mechanisms predisposing the patients to ulceration as well as GERD. Smoking cessation in addition to other systemic health benefits like reduction of cancer risk, may reduce dyspeptic symptoms as well as potentially prevent ulcers in some patients.
• Alcohol has direct toxic effects on the gastric mucosa and may lead to gastritis and even gastrointestinal bleeding in some cases. Excessive drinking also increases gastroesophageal reflux. Mixed drinks like bloody Mary, screw driver have components (tomato juice and orange juice etc) that have additional injurious effect on esophageal mucosa. Many after dinner drinks have in addition to alcohol sweetened cream etc leading to slower gastric emptying and more gastroesophageal reflux. Avoiding excess alcohol may help reduce dyspeptic symptoms as well as ulcers in otherwise predisposed individuals.
• Routine life style measures for GERD in addition to the above include avoiding large fatty, spicy meals especially at dinner, not going to bed for atleast 3 hours after supper, weigh reduction if overweight.
• Role of diet is frequently patient specific and may play a role in symptoms in some individuals with dyspepsia. Thus dietary modifications need to be individualized based on patient’s symptom triggers. Patients usually know the foods that trigger their symptoms and they should be asked to avoid them instead of looking for a treatment. Pharmaceutical therapy is not a good substitute for any particular food just because they “like that food” and “cannot give it up”.Patients suffering from recurrent peptic ulcer disease may benefit from eating complex carbohydrates, fresh fruit, vegetables and avoiding red and fried meats.

Constipation, dolichocolon and colonic kinks

Dolichocolon causes constipation-really? What is dolichocolon anyway and what is the evidence to support its role in constipation.

The Dolichocolon concept was the brainchild of Arbuthnot Lane and is based on the the theory that kinking of colon leads to constipation. While colon is like a country road with its own twists and turns (and of course each "colonic country road" is different), the Lane theory suggests that gravity leads to unnatural "kinking" or twisting initially in the fixed parts of colon on the left side. It gradually progresses upward and proximally causing elongation and further kinking.

In fact, Lane was a proponent of colonic resection or a byepass. While initially colonic resection became very popular, it came into disrepute in the early 20th century and now is performed in rare selected cases only.

Lets face it-the concept of dolichocolon or kinking causing a partial obstruction appears simple, straightforward, appealing and plausible (perhaps too simple and straightforward). Furthermore, theoretically speaking, the kinking along with elongation of colon has potential for increased fecal stasis in colon leading to increased water absorption from the fecal contents resulting in "drier" stool and constipation. However, scientific data to support these theoretical concepts is lacking. At the same time, constipation does not appear to be correlated with colonic length and surgery is not beneficial in cases of colonic "kinks" unless a volvulus is present.

Do you or someone close to you have constipation? What is the cause of constipation in your opinion? Does the Lane's theory of dolichocolon make sense and sound believable to you? Please share your thoughts. And click here to read about toilet posture.

Stool stasis, autointoxication due to fecal matter

Undigested food staying in gut too long, creating toxins leading to disease--have you heard of this?

The phenomenon is known as autointoxication and has its origins in ancient Egyptian civilization as far back as 16th century BC. Sir William Lane in the early 20th century in his treatise published in the Proceedings of the Royal Society of Medicine (1913) asserted that "autointoxication is the cause of all the chronic diseases of civilization".

Is this concept of autointoxication a fact or a myth?  The proponents argue that slowed gut transit or increased stasis of fecal matter in the colon results in greater putrefaction and production of toxins. These toxins get absorbed and cause chronic illnesses with or without low grade inflammation.

It is difficult to demonstrate such a toxin experimentally especially since such a toxin(s) may not be universally present. It is entirely possible that a multitude of toxins is involved and the disease results from individual susceptibility. Furthermore, there may not be a special toxin, but the disease may be a consequence of some normal product of bacterial putrefaction that is not necessarily absorbed but has a direct action on colonic wall affecting the gut immune cells, endocrine-neuro-immune system and ultimately the entire body system. In addition to all the above unknowns, we cannot exclude the possibility of yet unknown toxin being involved.

So what is the verdict? Is the concept of autointoxication a hard fact or just a myth perpetuated by "quacks" over the centuries. We do not have the perfect answer, atleast not yet. One thing we do know however that having a bowel movement everyday is essential for positive health.

What are your thoughts on autointoxication? Do you or someone you know believe in and practice any methods  to counter it? Please share your thoughts.