# FYI



## eric (Jul 8, 1999)

Diet and GI disorders - a curse for the Italian gastroenterologist. Mario Guslandi, Milan, Italy, 05 June 2002 As everybody knows, food is an important aspect of life in Italy. Not surprisingly, the influence of food on health is taken into serious consideration here, especially as regards the digestive system, the function of which is to receive, digest, and absorb food. Not only ordinary people, but (alas!) some general practitioners are keeping alive prejudices about alimentary regimens supposedly helpful or unwholesome for patients affected by disorders of the digestive system. Old myths die hard. For instance, many patients still believe that eggs are bad for the liver. This odd idea derives from the fact that for decades gallstones were popularly referred to as 'liver' stones. Eggs were able to trigger a 'hepatic' colic, hence were harmful for the liver in general. Similar mistaken claims are made about fried food. However, at the same time, it is often difficult to convince subjects with decompensated liver cirrhosis of the fact that that salt intake must be strictly avoided. Even caeliac patients do not easily accept the idea that a gluten-free diet is the only therapeutic measure for their disease, and that no effective pharmacological treatment is available. If they do understand that concept, they don't like it, since bread and pasta are pivotal in the Italian diet and the idea of buying gluten-free pasta at the pharmacy instead of normal pasta at the grocery store is extremely unattractive. On the other hand, as a gastroenterologist practising in Italy, I am plagued by continual requests for dietary advice from patients with gastroduodenal disorders, who cannot believe that food is not responsible, at least to some extent, for their symptoms. Elderly general practitioners still recommend the so-called 'white' diet, which means for instance eating spaghetti served with butter and/or oil (which substantially delay gastric emptying!!) instead of the (harmless) classic tomato sauce. . . Both dyspeptic patients and subjects with GERD are often told to refrain from 'acidic' beverages such as orange juice or lemonade, while coca-cola is seldom mentioned. The task of the poor Italian gastroenterologist is that of clearing away all this junk - or at least trying to sort it out.  Although it is known that coffee and coca-cola can increase gastric acidity, a moderate consumption is not harmful, while the patient's attention must be drawn to other damaging factors (e.g. NSAIDs). In contrast, subjects with GERD have to be warned against the relaxing effect on LOS of chocolate, alcohol (especially white wine), coffee, and mint - the latter being usually above any suspicion to the average patient. IBD patients often wonder about the fact that, among the various etiopathogenetic hypotheses suggested, the role of food remains neglected. The gastroenterologist's statement that no particular diet is necessary is received with astonishment, and the specialist feels forced to point out the existence of foods such as chocolate, grapes, and beans that should be consumed in limited amounts, as they can cause abdominal discomfort even in healthy people. Similar recommendations also apply to patients with irritable bowel syndrome, who are even more persistent in pestering the gastroenterologist for dietary advice. To most IBS patients, food is a natural enemy, food allergies being often suspected as a possible cause for their intestinal symptoms. Milk and cheese are the most common suspects, although refraining from lactose-containing food seldom results in any clinical benefit. Incidentally, yogurt is considered more favourably by many patients because of its lactobacilli content, supposedly helpful for any intestinal ailment. But the Italian IBS patient has often a very poor and limited diet, since the number of foods eliminated due to their possible adverse effects on the colon increases with time. Some symptoms (i.e. the stimulus to defecate shortly after a meal) are quoted by the patients as evidence that there is something harmful in what they eat. To explain that gastro-colonic reflex is enhanced in many IBS patients and triggered by the act of eating itself and not by the type of food ingested is usually a very difficult task. Strict, self-imposed diets are almost the rule in these patients, although they cannot obtain any improvement whatsoever in their symptoms. To add to the confusion, printed diets for 'colitic' patients are sometimes distributed in the offices of general practitioners. The source of those diets is always untraceable and the diets suggested contradictory. To encourage IBS patients to resume a normal diet, and thus to brighten up their life a little bit, is certainly one of the main parts of that general reassuring attitude which constitute a primary role of gastroenterologists in the treatment of this common disorder. A high-fiber diet is usually recommendable in IBS patients with constipation, while its benefits in those with diarrhea are questionable. Now I should complete my Soapbox with a score of references to support my opinions, shouldn't I? The fact is that in some instances it is extremely hard to find evidence-based data confirming what we all take it for granted and can also find reported in serious textbooks. In contrast, for other controversial dietary aspects, the number of references to quote is overwhelming. Again, the Italian gastroenterologist is haunted by a curse, which extends even to the reference list. Maybe the Editors will invite me to write a real review article in one of their journals, where I will be able to luxuriate in an ocean of scientific quotations.


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## BQ (May 22, 2000)

Yeah, "To mangia or not to mangia" that is the ?Interesting but not surprising he had very little in the way of research studies to back up what he was saying.Too bad man can't live on red wine alone.







I have found only when I'm REALLY flaring with D do I have a problem with tomato sauce. I really love tomatoes. I rarely have trouble with sliced fresh tomatoes. I really, really love V8 juice. I would drink it everyday but, you know, too much of a good thing and all, AND not to mention the other ingredients may be a bit harsh. So I spread it out and have no trouble. I limit myself to a six pack of the lil cans every once in awhile. But I can and have eaten fresh tomatoes daily and they are just fine on my gut.It is amazing how some foods get a bad rap and keep it despite science saying different. lolBQ


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