April is the cruellest month…

I wonder if T.S. Eliot1 was suffering from diarrhoea when he wrote this line? I believe English literary history generally has him down as recuperating from a nervous breakdown at the time, but who knows?2

So what is the tenuous link between T.S. Eliot’s The Waste Land and diarrhoea? It’s not necessarily what you’re thinking…

April has been designated National Irritable Bowel Syndrome Month by the USDA. Surely that’s cruel enough. The symptoms available are pretty unpleasant and range from discomfort to flatulence to diarrhoea. Sufferers can be running to the toilet or undoing their trouser buttons, depending on the severity of the reaction.

IBS also isn’t a nutritional disease in the classical sense; it’s a collection of symptoms with a range of aetiologies that share some common characteristics. I don’t think writing poetry has been described as a symptom, or even a cause, as yet. However, given the wide array of variables described in the literature, it may not be long before something turns up.

A search of CAB Abstracts’ 480 records alone on ‘irritable bowel syndrome‘ throws up bacterial infections, allergy, food intolerance, immuno-modulatory and neuronal pathogenicities as causes. Nutritionally, it can be triggered by eating fatty foods, dairy products, chocolate, alcohol, caffeine and carbonated drinks, according to the NDDIC. CAB Abstracts adds wheat based foods, a lack of fruits and vegetables3 and narrows the active ingredients to sugars (sorbitol, xylitol, fructose), fats, lactose, gluten and gliadin, coffee, alcohol and fibre4. Clearly in the literature there is considerable overlap between IBS with other intestinal disorders, particularly food allergies, malabsorptive diseases, gastritis and ulcerative colitis, so it tends to get lumped in with these. The treatments discussed are also fairly similar.

One of the most common non-drug treatments cited is the use of probiotics; and many functional products are under development to alleviate the symptoms of IBS sufferers and other people with intestinal discomfort. Guslandi (2007) reviewed the topic last year, proposing a role for probiotics in cases where IBS has been caused by a bacterial or viral infection, or where an altered or abnormal intestinal microflora has been identified. Drisko and colleagues (2006) propose a food elimination diet followed by food challenge, as well as probiotics.

Importantly, Rescha and colleagues (2007) draw our attention to the dangers of nutritional deficiencies in patients trying desperately to control their intestinal discomfort by eliminating certain foods from their diet.

Top marks for originality, however, must surely go to Borody and colleagues for their 2004 paper entitled, ‘Bacteriotherapy using fecal flora: toying with human motions‘. Poetry in motion!

1From The Waste Land by T.S. Eliot (1922)

2 One of the treatments suggested recently by the National Digestive Diseases Information Clearinghouse (NDDIC) is a course of antidepressants, to combat the stress that can be a compounding, if not a resultant factor of the disease.

3Rescha, A. Pieczy?ska, J. Ilow, R. Grajeta, H. Soba?ska, A. Blachut, K., Smereka, A., Biernat, J., Paradowski, L. (2007) Dietary habits of patients with irritable bowel syndrome. (Foreign Title: Zwyczaje ?ywieniowe pacjentów z zespolem jelita nadwra?liwego.) ?ywienie Czlowieka i Metabolizm Vol. 34, No. 3/4, pp. 1138-1142

4 E.g. McGuire, J. D. and Towers, P.A. (2006). Irritable Bowel Syndrome. Journal of Complementary Medicine Vol. 5, No. 1, pp. 12-25

Guslandi, M. (2007). Probiotic agents in the treatment of irritable bowel syndrome. Journal of International Medical Research, 2007, Vol. 35, No. 5, pp. 583-589.

Drisko, J. , Bischoff, B. , Hall, M. , McCallum, R. (2006) Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. Journal of the American College of Nutrition, 2006, Vol. 25, No. 6, pp. 514-522.

Rescha, A. , Pieczy?ska, J. , Ilow, R. , Grajeta, H. , Soba?ska, A. , Blachut, K. , Smereka, A. , Biernat, J. , Paradowski, L. (2007). Dietary habits of patients with irritable bowel syndrome. ?ywienie Czlowieka i Metabolizm Vol. 34, No. 3/4, pp. 1138-1142.

Borody, T.J., Warren, E.F., Leis, S.M., Surace, R., Ashman, O. and Siarakas, S. (2004). Bacteriotherapy using fecal flora: toying with human motions. Journal of Clinical Gastroenterology, Vol. 38, No. 6, pp. 475-483.

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