Chained to the Bathroom
From The McDougall Newsletter
We all can recall the painful distress from a bad case of the stomach
flu or a bout with “traveler’s diarrhea.” Can you imagine this happening
almost everyday – all day long? Unfortunately, for some people this is a
way of life. They know where every bathroom is in every building in
every town they visit. They fear going out of their home because of the
sudden onset of stomach pains and an uncontrollable urge to move their
bowels; followed by a torrent of diarrhea – sometimes accompanied by
blood and mucus. This distress is most commonly due to inflammation of
the large intestine (colon) and is called colitis. The cause can range
from an infection with a bacteria, parasite, or virus to an allergic
reaction from a disagreeable food. And the troublesome agent can come to
the colon from the remnants of food flowing inside the intestine or
through the bloodstream. When the colitis is short-lived there are
usually no serious consequences – and people recover fully. However,
there are chronic forms that never go away and are resistant to all the
drugs modern medicine has to offer.
The reason that these forms never go away is because the cause of the
colitis never stops. In other words, whatever is the source of the
colitis continues to attack, injuring the body, and in this case most
noticeably the colon. So the solution to this chronic condition is to
find the offending agent and eliminate it. Modern medicine can do this
in some cases of chronic parasite infections, like Giardia, with the use
of antibiotics. But most cases of chronic colitis are incurable because
the offending agent remains elusive.
Why is Chronic Colitis Incurable?
The main reason chronic colitis is rarely healed is because almost
all practicing doctors believe that the foods we eat have little or
nothing to do with the health of our intestine (or for that matter our
entire body). They cannot imagine that what remains for hours and
sometimes days in contact with the lining of our intestinal tract could
have a thing to do with its health. This misunderstanding is as
preposterous as a doctor believing that what people breathed had no
affect on their lung health or that substances that contact a patient’s
skins rarely caused skin disease.
So the first step in curing any chronic disease, including chronic
forms of colitis, is to recognize that the most intimate contact the
body, and especially the colon, has with the world around us – is our
food. The second step is to understand that the rich American diet is
the wrong food for people. Acceptance of these two premises is essential
to solving common forms of colitis.
Chronic colitis can range from very mild and hardly noticeable to
severe and life threatening – and all levels in between. However, the
following discussion will artificially divide the colitis into mild and
Mild Chronic Colitis
Mild chronic colitis is commonly known as irritable bowel syndrome
(abbreviated IBS – also known as spastic colitis and spastic colon).
This disorder accounts for nearly 50% of referrals to
gastroenterologists. IBS affects mostly women and is seen in as many as
24% of women and 15% of men in Western societies.
The primary symptoms of IBS are abdominal pain, bloating, feeling of
incomplete evacuation, and poor bowel function. This may present as
either predominately diarrhea or constipation, or alternation between
these two extremes. I learned in medical school that this was primarily
a disease of “neurotic, middle-aged, women.” But, that was from my same
doctor-mentors who taught me that diet had nothing to do with disease.
The idea that the mind can cause bowel disease has been one of the
fundamental teachings for medical students and doctors for decades. We
learn that stress will cause acid indigestion and stomach ulcers, and
that IBS is a neurosis. Stop and think: the brain is a long way from the
colon, and to make that conclusion over the more obvious one – that the
food that bathes every inch of our intestinal tract is the cause – is a
long stretch. Life is difficult with constant emotional challenges, but
have faith that what you put in your intestinal tract determines its
Dietary Treatment of IBS
The contents of the intestinal tract – the American (Western) diet –
are the obvious place to look for cause and cure of IBS. There are many
qualities of this diet that make the intestine inflamed. This diet is
high in fat, indigestible milk sugar (lactose), and low in dietary
fiber, carbohydrates, and plant chemicals (phyto-chemicals). Many of the
food proteins cause allergic reactions. Specific food intolerances are
argued to be involved in as many as 58% of cases of IBS and the most
likely offenders are milk, wheat and eggs. 1-4
Adding fiber to the diet of patients with IBS has shown to
significantly improve their symptoms.6 Most of the experiments have been
done using supplements of wheat bran or guar gum.7 Constipation is
helped much more than the diarrhea-type of IBS with the addition of
these fiber supplements.7 There are, however many different kinds of
fibers in plant foods which have many functions in the bowel. Therefore,
I have found the benefits from a change to a plant-based diet with
hundreds of naturally healthy fiber to be much greater than those seen
with a single fiber source.
IBS has also been effectively treated with the addition of “friendly
intestinal bacteria,” called probiotics.8-10 Organisms used in one
study, Lactobacillus plantarum, resulted in all patients reporting
resolution of abdominal pain and half of them had relief of
constipation.8 Eating a healthy, plant-based diet causes healthy
bacteria to grow in the intestine, because these bacteria like to eat
the plant sugars (oligosaccharides) found in starches, vegetables, and
My experience has been that a change to a low-fat, plant-based diet
(a diet based on starches, vegetables and fruits) results in almost
immediate relief of bowel cramps, diarrhea, and constipation. This is
due to many qualities of the vegetable foods. For the very few people
who continue to have symptoms, I will eliminate wheat – to which some
people may be sensitive. As a last resort I will ask these people to
follow an elimination diet. (A very effective elimination diet is found
at www.drmcdougall.com under “Common Diseases, Allergic Diseases.”) It
seems a shame to blame the patient by calling her neurotic when the
intestinal tract is the obvious place to look for a solution.
Severe forms of colitis are known as inflammatory bowel disease (IBD)
and encompass two categories of disease called ulcerative colitis (UC)
and Crohn’s Disease (CD). These diseases resemble each other so closely
that it is hard for doctors to distinguish between them and for
practical purposes can be considered almost identical, since the cause
and treatments are essentially the same. In a practical world, doctors
do not know the cause and the treatments never cure the diseases; and
all that is offered the suffering patients are temporary benefits with
plenty of costs and side effects – in other words a multitude of
IBD is a chronic inflammatory condition causing patients to suffer
with abdominal pains, bloody diarrhea and mucus. The diagnosis is made
when there is no other cause found by negative stool cultures for
bacteria, ova, or parasites. This is an autoimmune disease, where the
body attacks the bowel tissues.
Evidence for a Dietary Cause
IBD is found exclusively in societies where people eat the Western
diet. Worldwide this disease is more commonly found in northern than
southern populations – this trend parallels the consumption of the
Western diet -- the incidence increasing worldwide as people change from
unrefined plant-based diets to diets of meat, dairy products and refined
People with UC have been found to have higher intakes of animal
protein than the general population has.12 Patients with high levels of
antibodies to whole milk are more likely to have rapid relapses than are
patients with low levels of these milk antibodies.13 A high intake of
refined carbohydrates and a lower intake of fruits and vegetables has
been associated with Crohn’s Disease.14-15 Patients with UC are likely
to have symptoms induced by cow’s milk. 16 A study from Japan of UC
patients found that margarine or chemically modified fat may play a role
in the development of ulcerative colitis.17
Sulfur compounds may also play an important role in the cause of IBD.
Hydrogen sulfide has been found to be toxic to the cells of the
colon.19-20 This substance is produced in the bowel by the action of
bacteria on dietary sources of sulfur – more specifically,
sulfur-containing amino acids. Animal products are the main sources of
these amino acids.21 Compare the relative amounts of methionine, a
common sulfur-containing amino acid, in these foods (based on calories):
Beef provides 4 times more than pinto beans
Eggs have 4 times more than corn
Cheddar cheese has 5 times more than white potatoes
Chicken provides 7 times more than rice
Tuna provides 12 times more than sweet potatoes (Giving a whole new
understanding of “fish farts.”)
Dietary Treatment of Severe Colitis
Very basic diets consisting of mostly sugar and water called
elemental diets have been found to be very effective at relieving acute
flare-ups of Crohn’s Disease. Possibly their benefits come from the fact
that they contain no intact protein to cause an autoimmune reaction with
the gut. One study compared formulas with no intact protein with another
formula with intact milk protein. Remission was found in only 36% of
those taking the formula with milk protein, but 75% on the protein-free
In one recent large scale controlled study, 93 unselected patients
with CD followed an elimination diet and 84% achieved remission after 2
weeks. Food intolerances discovered were predominately cereals, dairy
products and yeast.23 However, only about 40% remained in remission
after 2 years and this was largely due to poor compliance with the diet.
A previous study of self-selected (therefore, more compliant) patients
had shown that two-thirds of patients treated with diet were well after
2 years.24 Many other studies have found significant benefits from
treating patients with IBD by a healthy largely plant-based diet that
eliminates or reduces the intake of animal protein and/or fats.25-30
An important study was performed with Crohn's Disease patients who
had been suffering from severe diarrhea for many years, with 20 stools
or more per day.31 The subjects were changed from a high-fat diet to one
low in fats. This gave relief from the frequent watery stools within two
to three days. Most patients continued to form solid bowel movements-as
long as they kept the animal and vegetable fats out of their diet.
A person with a functioning healthy small intestine re-absorbs the
bile secreted from the liver in the last part of the small intestine,
called the ileum. In patients with Crohn's Disease, this portion of the
ileum often is damaged and unable to absorb the bile. Bile continues to
flow through the ileum into the large intestine, where it causes
irritation and discharge of mucus and water. In these patients, the
immediate benefit from a change in diet is the decrease in bile acids
produced by the liver as a response to lowering the fat content of the
foods eaten. In addition, the fibers introduced in a plant-based diet
bind and neutralize many of the bile acids and absorb free water present
in the stool.
Diet for the Treatment of Chronic Colitis
Obviously, the contents of the bowel must have a determining effect
upon its health. Therefore, logic dictates that a person wishing to keep
his/her bowels healthy should put good foods in them. Whether it is
heart disease, cancer, obesity or diabetes that is being discussed, the
diet that is recommended is a diet high in complex carbohydrates and low
in animal foods and fats – in other words a plant-based diet. There
should be no surprise that the same diet is “bowel-healthy” too.
I believe the best diet for preventing and treating all forms of
colitis is based upon starches with the addition of fruits and
vegetables. This diet is also devoid of all free fats (all vegetable
oils) and all animal products. If this fails to resolve the problems
then the next step is to eliminate wheat products. Finally, the
elimination diet should be tried to search out any offending foods. With
this approach I have seen most people with colitis improve and many
cured of their conditions – including those with the more serious forms
of IBD. There is no reason not to believe this and try a healthy diet
for a period of time (say 4 months). There are no added costs and no
side effects from this approach and there is a real possibility of
excellent health being the result.
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