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Effects of fasting therapy on irritable bowel syndrome
Abstract
How to treat patients with irritable bowel syndrome (IBS) who do not respond to pharmacotherapy is an unsolved problem. Psychotherapy, which has been reported on in previous studies, is available only in specific centers. We describe in this study a novel and simple psychotherapy; that is, the fasting therapy (FT) for treatment of patients with IBS. Of 84 inpatients with IBS, 58 patients who still had moderate to severe IBS symptoms after 4-week basic treatment were investigated retrospectively. Of the 58 patients enrolled in this study, 36 underwent FT, whereas the remaining 22 received a consecutive basic treatment (control therapy). There were no significant differences in the 4-point severity scales of gastrointestinal and psychological symptoms between the 2 groups before the start of FT. The basic treatment consisted of pharmacotherapy and brief psychotherapy, whereas the FT consisted of 10 days of starvation followed by 5 days of refeeding. Changes in scores of symptoms before and after each treatment were analyzed. FT significantly improved 7 out of the 10 symptoms assessed; that is, abdominal pain-discomfort (p < .001), abdominal distension (p < .001), diarrhea (p < .001), anorexia (p = .02), nausea (p < .01), anxiety (p < .001), and interference with life in general (p < .001). However, the control therapy significantly improved only 3 out of the 10 symptoms assessed; that is, abdominal pain-discomfort (p = .03), abdominal distension (p < .01), and interference with life (p = .01). Our results suggest that FT may have beneficial effects on intractable patients with IBS.
... D ifferent types of diseases have been treated by restricted caloric intake or fasting, for example, rheumatoid arthritis, [1] obesity, [2,3] type-2 diabetes, [3] schizophrenia, [4] various neurological diseases, [5] prevention and treatment of cancer, [6] and irritable bowel syndrome (IBS). [7] Moreover, continuous fasting was considered beneficial for some diseases such as IBS. In a study, a group of people suffering from IBS were treated with pharmacotherapy and psychotherapy with a period of 10 consecutive days of fasting therapy (FT). ...
... Although, nowadays, prolonged fasting is not a suggestive therapy for IBS, the results showed that FT has beneficial effects on intractable patients with IBS. [7] circulating blood from the extracellular fluid of the brain. This barrier is often compromised in different conditions such as neurodegenerative diseases, stroke, epilepsy, diabetes, traumatic brain injury, and many others. ...
... Nowadays, restricted caloric intake or fasting is considered a treatment for several diseases, including 10 consecutive days of fasting for the treatment of IBS. [7] This prolonged fasting of treatment motivated us to examine the status of BBB during prolonged fasting since this BBB barrier is often compromised in different conditions. [8] There are two major findings of the current study. ...
INTRODUCTION: Different types of diseases have been treated by restricted caloric intake or fasting. Although during this long time, fasting protective measures, for example, supplements, are given to the patients to protect vital organs such as the liver and kidney, little attention is given to the brain. The current research aims to investigate hypoglycemia due to prolonged fasting disrupts blood-brain barrier (BBB) in mice.
... D ifferent types of diseases have been treated by restricted caloric intake or fasting, for example, rheumatoid arthritis, [1] obesity, [2,3] type-2 diabetes, [3] schizophrenia, [4] various neurological diseases, [5] prevention and treatment of cancer, [6] and irritable bowel syndrome (IBS). [7] Moreover, continuous fasting was considered beneficial for some diseases such as IBS. In a study, a group of people suffering from IBS were treated with pharmacotherapy and psychotherapy with a period of 10 consecutive days of fasting therapy (FT). ...
... Although, nowadays, prolonged fasting is not a suggestive therapy for IBS, the results showed that FT has beneficial effects on intractable patients with IBS. [7] circulating blood from the extracellular fluid of the brain. This barrier is often compromised in different conditions such as neurodegenerative diseases, stroke, epilepsy, diabetes, traumatic brain injury, and many others. ...
... Nowadays, restricted caloric intake or fasting is considered a treatment for several diseases, including 10 consecutive days of fasting for the treatment of IBS. [7] This prolonged fasting of treatment motivated us to examine the status of BBB during prolonged fasting since this BBB barrier is often compromised in different conditions. [8] There are two major findings of the current study. ...
INTRODUCTION
Different types of diseases have been treated by restricted caloric intake or fasting. Although during this long time, fasting protective measures, for example, supplements, are given to the patients to protect vital organs such as the liver and kidney, little attention is given to the brain. The current research aims to investigate hypoglycemia due to prolonged fasting disrupts blood–brain barrier (BBB) in mice.
MATERIALS AND METHODS
Immunohistochemistry (IHC) and in situ hybridization (ISH) techniques were used to examine the expression of different genes. Evans blue extravasation and wet–dry technique were performed to evaluate the integrity of BBB and the formation of brain edema, respectively.
RESULTS
We confirmed that hypoglycemia affected mice fasting brain by examining the increased expression of glucose transporter protein 1 and hyperphosphorylation of tau protein. We subsequently found downregulated expression of some genes, which are involved in maintaining BBB such as vascular endothelial growth factor ( VEGF ) in astrocytes and claudin-5 (a vital component of BBB) and VEGF receptor ( VEGFR1 ) in endothelial cells by ISH. We also found that prolonged fasting caused the brain endothelial cells to express lipocalin-2, an inflammatory marker of brain endothelial cells. We performed Evans blue extravasation to show more dye was retained in the brain of fasted mice than in control mice as a result of BBB disruption. Finally, wet–dry method showed that the brain of prolonged fasted mice contained significantly higher amount of water confirming the formation of brain edema. Therefore, special attention should be given to the brain during treatment with prolonged fasting for various diseases.
CONCLUSIONS
Our results demonstrated that hypoglycemia due to prolonged fasting disrupts BBB and produces brain edema in wild-type mice, highlighting the importance of brain health during treatment with prolonged fasting.
... -6 articles allemands (Michalsen, Schlegel et al. 2003;Huber, Nauck et al. 2005;Michalsen, Hoffmann et al. 2005;Michalsen, Riegert et al. 2005;Michalsen, Kuhlmann et al. 2006;Abendroth, Michalsen et al. 2010) Les Etats-Unis ont publié 4 articles (Johnson and Drenick 1977;Goldhamer, Lisle et al. 2001;Goldhamer, Lisle et al. 2002;Safdie, Dorff et al. 2009), et le Japon 3 articles (Masuda, Nakayama et al. 2001;Nakamura, Shimoji et al. 2003;Kanazawa and Fukudo 2006 Kjeldsen-Kragh, Haugen et al. 1991;Peltonen, Kjeldsen-Kragh et al. 1994;Kjeldsen-Kragh, Mellbye et al. 1995;Kjeldsen-Kragh, Rashid et al. 1995;Huber, Nauck et al. 2005;Kanazawa and Fukudo 2006) o 5 essais comparatifs non randomisés (Fraser, Thoen et al. 2000;Michalsen, Hoffmann et al. 2005;Michalsen, Riegert et al. 2005;Michalsen, Kuhlmann et al. 2006;Abendroth, Michalsen et al. 2010) -9 études observationnelles (Johnson and Drenick 1977;Kjeldsen-Kragh, Hvatum et al. 1995;Kjeldsen-Kragh, Kvaavik et al. 1995;Kjeldsen-Kragh, Sumar et al. 1996;Goldhamer, Lisle et al. 2001;Goldhamer, Lisle et al. 2002;Michalsen, Schlegel et al. 2003). Deux de ces essais (Kjeldsen- Kragh, Hvatum et al. 1995;Kjeldsen-Kragh, Sumar et al. 1996) sont des études complémentaires à l'essai contrôlé randomisé de Kjeldsen-Kragh (Kjeldsen- Kragh, Haugen et al. 1991). ...
... -6 articles allemands (Michalsen, Schlegel et al. 2003;Huber, Nauck et al. 2005;Michalsen, Hoffmann et al. 2005;Michalsen, Riegert et al. 2005;Michalsen, Kuhlmann et al. 2006;Abendroth, Michalsen et al. 2010) Les Etats-Unis ont publié 4 articles (Johnson and Drenick 1977;Goldhamer, Lisle et al. 2001;Goldhamer, Lisle et al. 2002;Safdie, Dorff et al. 2009), et le Japon 3 articles (Masuda, Nakayama et al. 2001;Nakamura, Shimoji et al. 2003;Kanazawa and Fukudo 2006 Kjeldsen-Kragh, Haugen et al. 1991;Peltonen, Kjeldsen-Kragh et al. 1994;Kjeldsen-Kragh, Mellbye et al. 1995;Kjeldsen-Kragh, Rashid et al. 1995;Huber, Nauck et al. 2005;Kanazawa and Fukudo 2006) o 5 essais comparatifs non randomisés (Fraser, Thoen et al. 2000;Michalsen, Hoffmann et al. 2005;Michalsen, Riegert et al. 2005;Michalsen, Kuhlmann et al. 2006;Abendroth, Michalsen et al. 2010) -9 études observationnelles (Johnson and Drenick 1977;Kjeldsen-Kragh, Hvatum et al. 1995;Kjeldsen-Kragh, Kvaavik et al. 1995;Kjeldsen-Kragh, Sumar et al. 1996;Goldhamer, Lisle et al. 2001;Goldhamer, Lisle et al. 2002;Michalsen, Schlegel et al. 2003). Deux de ces essais (Kjeldsen- Kragh, Hvatum et al. 1995;Kjeldsen-Kragh, Sumar et al. 1996) sont des études complémentaires à l'essai contrôlé randomisé de Kjeldsen-Kragh (Kjeldsen- Kragh, Haugen et al. 1991). ...
... -un groupe sans intervention nutritionnelle ni autre type d'intervention Huber, Nauck et al. 2005;Kanazawa and Fukudo 2006). ...
... Continuous calorie reductions and intermittent fasting, which involves cycles of fasting and eating periods, are common strategies for weight control and coping with overnutrition (Michalsen, 2010;Fond et al., 2013). Long-term complete fasting has been practiced as a clinical treatment, e.g., complete fasting for 10 days for patients with irritable bowel syndrome (Kanazawa and Fukudo, 2006) and even for 4 weeks fasting for euthyroid obese volunteers (Vagenakis et al., 1975). These fasting practices demonstrate that it is possible and safe for people to fast as long as an effective and suitable fasting protocol is in place. ...
... The contradictions between these results concerning the effect of fasting on psychological responses may be the result of varying fasting protocols and different participant groups. Previous studies have used various types of fasting designs: calorie restriction (Hussin et al., 2013), intermittent fasting (e.g., alternative day fasting, Varady et al., 2013), Ramadan fasting (Nugraha et al., 2017), and continuous complete fasting (e.g., 18 h, Watkins and Serpell, 2016;2 days, Solianik and Sujeta, 2018; and 10 days, Kanazawa and Fukudo, 2006). Participant groups have also varied in age (young, e.g., 26 years old: Nugraha et al., 2017;and older, e.g., 59 years old: Hussin et al., 2013), gender (female: Watkins and Serpell, 2016;male: Nugraha et al., 2017;and mixed gender: Uher et al., 2006) and health status (healthy participants: Watkins and Serpell, 2016;and patients: Kanazawa and Fukudo, 2006;Michalsen, 2010;Fond et al., 2013). ...
As an unusual event, fasting can induce strong physiological and psychological reactions, but there is still no clear understanding of how previous fasting experiences affect people’s responses to current fasting. This study aimed to investigate the influence of previous fasting experiences on participants’ basic physiological and psychological responses in a fasting experiment conducted under intensive medical monitoring. For a 22-day experiment divided into four phases (3-day Baseline; 10-day Complete Fasting; 4-day Calorie Restriction; and 5-day Recovery phases), a total of 13 persons participated; the participants were divided into a group with prior fasting experience (Experienced: N = 6) and a group without prior fasting experience (Newbie: N = 7). The results indicate no group differences in physiological responses (i.e., weight, glucose, and ketone bodies); however, differences in psychological states were observed, with the Newbie group showing more negative psychological states overall throughout the experiment (i.e., greater appetite, more negative mood states, more stress, less vitality, and fewer recovery resources). Hence, previous fasting experience may be a buffer against negative feelings during current fasting. For this reason, it is important to consider fasting experiences as a vital factor in future research.
... Zudem ist die Passivität des Patienten bei diesem Verfahren als ungünstig zu beurteilen, da die Evidenzlage bei funktionellen Störungen eindeutig aktive Verfahren favorisiert [350]. Qualitativ hochwertige Studien zum Heilfasten fehlen derzeit, die vorliegenden Daten deuten jedoch auf eine Verbesserung der Parameter RDS-spezifische Symptome, Depression, Ängstlichkeit und Lebensqualität hin [351]. Der Einfluss des Heilfastens auf die Darmflora bei RDS-Patienten und die Nachhaltigkeit eines möglichen positiven Effekts sind jedoch bislang ungeklärt. ...
... In einer Fallkontrollstudie an 58 therapierefraktären Patienten mit RDS wurden 36 Patienten einer Fastentherapie, 22 einer Pharmakotherapie plus Psychotherapie zugeführt. Die Fastentherapie führte zu einem besseren symptomatischen Ergebnis [351]. Hintergrund des Benefits von Eliminationsdiäten basierend auf IgG-Titern ist weniger wahrscheinlich ein allergisch/immunologischer Mechanismus wie bei der Nahrungsmittelallergie, sondern eher eine gestörte Darmbarriere, die zu einem Anstieg von IgG-Ak gegen Nahrungsproteine führen kann. ...
... Zudem ist die Passivität des Patienten bei diesem Verfahren als ungünstig zu beurteilen, da die Evidenzlage bei funktionellen Störungen eindeutig aktive Verfahren favorisiert [350]. Qualitativ hochwertige Studien zum Heilfasten fehlen derzeit, die vorliegenden Daten deuten jedoch auf eine Verbesserung der Parameter RDS-spezifische Symptome, Depression, Ängstlichkeit und Lebensqualität hin [351]. Der Einfluss des Heilfastens auf die Darmflora bei RDS-Patienten und die Nachhaltigkeit eines möglichen positiven Effekts sind jedoch bislang ungeklärt. ...
... In einer Fallkontrollstudie an 58 therapierefraktären Patienten mit RDS wurden 36 Patienten einer Fastentherapie, 22 einer Pharmakotherapie plus Psychotherapie zugeführt. Die Fastentherapie führte zu einem besseren symptomatischen Ergebnis [351]. Hintergrund des Benefits von Eliminationsdiäten basierend auf IgG-Titern ist weniger wahrscheinlich ein allergisch/immunologischer Mechanismus wie bei der Nahrungsmittelallergie, sondern eher eine gestörte Darmbarriere, die zu einem Anstieg von IgG-Ak gegen Nahrungsproteine führen kann. ...
... Zudem ist die Passivität des Patienten bei diesem Verfahren als ungünstig zu beurteilen, da die Evidenzlage bei funktionellen Störungen eindeutig aktive Verfahren favorisiert [350]. Qualitativ hochwertige Studien zum Heilfasten fehlen derzeit, die vorliegenden Daten deuten jedoch auf eine Verbesserung der Parameter RDS-spezifische Symptome, Depression, Ängstlichkeit und Lebensqualität hin [351]. Der Einfluss des Heilfastens auf die Darmflora bei RDS-Patienten und die Nachhaltigkeit eines möglichen positiven Effekts sind jedoch bislang ungeklärt. ...
... In einer Fallkontrollstudie an 58 therapierefraktären Patienten mit RDS wurden 36 Patienten einer Fastentherapie, 22 einer Pharmakotherapie plus Psychotherapie zugeführt. Die Fastentherapie führte zu einem besseren symptomatischen Ergebnis [351]. Hintergrund des Benefits von Eliminationsdiäten basierend auf IgG-Titern ist weniger wahrscheinlich ein allergisch/immunologischer Mechanismus wie bei der Nahrungsmittelallergie, sondern eher eine gestörte Darmbarriere, die zu einem Anstieg von IgG-Ak gegen Nahrungsproteine führen kann. ...
... One possible explanation for this connection is the disruption of circadian rhythms caused by night eating, which can interfere with the gastrointestinal system's natural functioning, leading to discomfort and distress. Fasting therapy, for example, has been reported to alleviate symptoms such as abdominal pain and diarrhea in individuals with irritable bowel syndrome [56], while low-fat, high-fiber diets have been shown to reduce gastrointestinal symptoms [57]. Our study adds to this literature by showing that night eating behavior, even outside of clinical eating disorders, may exacerbate gastrointestinal symptoms, which, in turn, could negatively impact psychological well-being. ...
Background
This cross-sectional study aimed to address the gap in understanding how night eating behavior impacts gastrointestinal health and psychological well-being in adult populations.
Method
This descriptive and cross-sectional study was conducted with 1372 adults aged 19–65 between September 2023 and November 2023. The research data were collected with the help of a web-based survey form (Google form) created by the researchers using the snowball sampling method. The demographic characteristics (sex, age, education level, marital status, income status), eating behaviors (number of main meals and snacks), and anthropometric measurements (body weight and height). Gastrointestinal symptoms observed in individuals were evaluated with the Gastrointestinal Symptom Rating Scale. The Night Eating Questionnaire (NEQ) was used to quantify the severity of night eating syndrome, and The Psychological Well-Being Scale was used to measure psychological well-being. All analyses were performed using the Statistical Package for the Social Sciences (version 27.0) software.
Results
A statistically significant negative correlation was found between the Psychological Well-Being Scale total score and Gastrointestinal Symptom Rating Scale subdimensions (r=-0.067, r=-0.067, r=-0.109, r=-0.068, r=-0.129, respectively). Also, a statistically significant negative correlation was found between the Psychological Well-Being Scale total score and the Night Eating Questionnaire total score (r=-0.287) (p < 0.05).
Conclusion
This study found a relationship between night eating syndrome, psychological well-being, and gastrointestinal symptoms. Nutritional strategies for night eating syndrome, an eating disorder, may have important consequences on the psychological well-being of individuals with night eating. Our study highlights the significant relationships between night eating behavior, gastrointestinal symptoms, and psychological well-being, suggesting that night eating may contribute to both physical and mental health challenges.
... Skipping breakfast adversely affects menstrual disorders as reported in 2 different studies in young college students of Japan and Palestine [88][89][90]. Women from developed countries are 2-4 times more likely to have IBS than men [91,92]. ...
Breakfast, the first meal of the day, is considered the most important meal throughout the day. As nutritionist Adelle Davis famously put it back in the 1960s: “Eat breakfast like a king, lunch like a prince and dinner like a pauper”. Breakfast is most commonly skipped meal more than lunch and dinner specifically in the young adult in the university study period and those who wake up late. Lack of time is the main reason behind skipping meals, in general, lack of appetite, inability to cook, fasting/religion, and not being hungry. Many people are used to be in a hurry for job, business, children’s’ school in the morning where a filled stomach may prevent them to walk a long way. It is obvious that the irregular omission of breakfast may be effective in energy intake reduction over the next 24 hours and in this day, exercise performance may be compromised. There is no evidence that breakfast skipping reduces overeating or prevent weight gain. Some people argue that breakfast and good health is a marketing strategy by breakfast companies.
... However, a study showed that fasting in IBD patients at the remission stage will not have a severe adverse effect (8). Fasting can reduce seven out of ten IBS symptoms, including abdominal pain, abdominal distension, diarrhoea, anorexia, nausea, anxiety and increase overall quality of life (9). ...
Introduction: Long-term fasting (>24 hours) can result in mucosal atrophy, reduced number of goblet cells (GCs) and Peyer’s patches (PPs), and changes in the gut microbiota. This study aimed to determine whether there is a difference in the morphology of intestinal mucosa between mice treated with Dawood fasting and those fed an ad libitum (AL) diet. Methods: An experimental study used ten mice (BALB/c) divided into two groups. One group was given food and drink AL (the AL group). The treatment group (the F group) fasted intermittently in 14-hour (5 p.m. to 7 a.m.) every other day. The study was conducted for 56 days. The faeces from the intestine were diluted 100-fold and cultured for microbiota colony counts. Haematoxylin and eosin staining was performed to observe the villus length (VL) and the area of PPs, and periodic acid-Schiff staining was used to examine the number of GCs. Results: There were no significant differences in the VL, GCs, PPs and the number of microbiota between the F group and the AL group with the respective p = 0.26 (369.54 ± 48.41 vs 307.16 ± 61.16) μm, p = 0.33 (10.42 ± 1.27 vs 9.15 ± 2.44), p = 0.8 (0.164 ± 0.069 vs 0.159 ± 0.089) mm2, and p = 0.64 (1.85 ± 0.97 vs 2.22 ± 1.43) CFU/ml. Conclusion: Dawood fasting has no effect on the histopathological condition of the intestinal mucosa, including the VL, GCs count, area of PPs and the number of microbiota in mice.
... A study from 2006 investigated the effect of 10 days of starvation followed by 5 days of refeeding in 58 IBS patients who still had moderate symptoms after 4 weeks of basic IBS treatment. They reported the fasting treatment to significantly improve 7 out of 10 IBS symptoms, whereas the control treatment (basic IBS advice) only improved 3 out of 10 symptoms [101]. Of note, this type of 10-day starvation is not transferable to a fasting-like diet implemented in everyday life. ...
Background:
Diet is one of the main modulators of the gut microbiota, and dietary patterns are decisive for gut-microbiota-related diseases, including irritable bowel syndrome (IBS). The low-FODMAP diet (LFD) is commonly used to treat IBS, but its long-term effects on microbiota, symptoms and quality of life (QoL) are unclear. Alternative dietary strategies promoting beneficial gut microbiota, combined with reduced symptoms and improved QoL, are therefore of interest.
Aims:
To review current evidence on the diet-microbiota-interaction as a modulator of IBS pathophysiology, and dietary management of IBS, with particular emphasis on strategies targeting the gut microbiota, beyond the LFD.
Methods:
Literature was identified through PubMed-searches with relevant keywords.
Results:
Dietary patterns with a low intake of processed foods and a high intake of plants, such as the Mediterranean diet, promote gut microbiota associated with beneficial health outcomes. In contrast, Western diets with a high intake of ultra-processed foods promote a microbiota associated with disease, including IBS. Increasing evidence points towards dietary strategies consistent with the Mediterranean diet being equal to the LFD in alleviating IBS-symptoms and having a less negative impact on QoL. Timing of food intake is suggested as a gut microbiota modulator, but little is known about its effects on IBS.
Conclusions:
Dietary recommendations in IBS should aim to target the gut microbiota by focusing on improved dietary quality, considering the impact on both IBS-symptoms and QoL. Increased intake of whole foods combined with a regular meal pattern and limitation of ultra-processed foods can be beneficial strategies beyond the LFD.
... As possible covariates suggested to be associated with gastrointestinal symptoms, (e.g., [27,28]), the sociodemographic characteristics, as shown in Table 1, were used as control variables in the analysis of this study. For example, gastrointestinal symptoms are associated with factors such as income [29], alcohol consumption [30], smoking habits [31], BMI [32], allergies [33], previous experience with therapy [34], and physical activity [35]. ...
Background:
Sensory processing sensitivity is a personality or temperamental trait defined as individual differences in the tendency to perceive and process both positive and negative stimuli and experiences. Studies have shown that high sensitivity is correlated with psychosocial health, including depression and anxiety. However, its relationship with physical health has not been clarified. To fill this gap, using a large sample size with sufficient statistical power, an adult sample not including university students, and a range of covariates, this study examined the association between gastrointestinal symptoms as an indicator of physical health and sensory processing sensitivity.
Methods:
In this cross-sectional study, the participants were 863 Japanese adults (female = 450; male = 413; Mage = 30.4 years; SD = 4.9) who completed a web-based questionnaire. We statistically controlled for sociodemographic characteristics and examined whether sensory processing sensitivity is correlated with gastrointestinal symptoms.
Results:
The results showed that highly sensitive individuals were more likely to experience a wide range of gastrointestinal symptoms in the past week, including reflux symptoms, abdominal pain, indigestion symptoms, diarrhea symptoms, and constipation symptoms, even when statistically controlling for the participants' sociodemographic characteristics.
Conclusions:
Our findings suggest that high sensory processing sensitivity is associated with physical health. Some of the potential causes of this are also discussed.
... Qualitativ hochwertige Studien zum Heilfasten fehlen derzeit, die vorliegenden Daten deuten jedoch auf eine Verbesserung der Parameter RDS-spezifische Symptome, Depression, Ängstlichkeit und Lebensqualität hin [660]. Der Einfluss des Heilfastens auf die Darmflora bei RDS-Patienten und die Nachhaltigkeit eines möglichen positiven Effekts sind jedoch bislang ungeklärt. ...
... As possible covariates suggested to be associated with gastrointestinal symptoms, (e.g., [27,28]), the sociodemographic characteristics, as shown in Table 1, were used as control variables in the analysis of this study. For example, gastrointestinal symptoms are associated with factors such as income [29], alcohol consumption [30], smoking habits [31], BMI [32], allergies [33], previous experience with therapy [34], and physical activity [35]. ...
Sensory processing sensitivity is a personality or temperamental trait defined as individual differences in the tendency to perceive and process both positive and negative stimuli and experiences. Studies have shown that high sensitivity is correlated with psychosocial health, including depression and anxiety. However, its relationship with physical health has not been clarified. To fill this gap, this study focused on gastrointestinal disease symptoms as an indicator of physical health and examined their relationship with sensitivity. Participants were 863 Japanese adults (female = 450; male = 413; Mage = 30.4 years; SD = 4.9) who completed a web-based questionnaire. As a result, highly sensitive persons were more likely to report experiencing a wide range of gastrointestinal disease symptoms in the past week, including reflux syndrome, abdominal pain, indigestion syndrome, diarrhea syndrome, and constipation syndrome, even when statistically controlling for the participants’ sociodemographic characteristics. Our findings suggest that high sensory processing sensitivity is not only associated with psychosocial health, but also with physical health. Some of the potential causes of this are also discussed.
... Qualitativ hochwertige Studien zum Heilfasten fehlen derzeit, die vorliegenden Daten deuten jedoch auf eine Verbesserung der Parameter RDS-spezifische Symptome, Depression, Ängstlichkeit und Lebensqualität hin [660]. Der Einfluss des Heilfastens auf die Darmflora bei RDS-Patienten und die Nachhaltigkeit eines möglichen positiven Effekts sind jedoch bislang ungeklärt. ...
... The most recent study which highlights the above mentioned aspects is dating from 2006 where Kanazawa et al.,(62) enrolled 84 patients with IBS, from which 58 had fluctuating symptoms after 1 month of basic treatment. Of 58 patients, 36 underwent FT and 22 basic therapies with no important differences in the four-point severity scale. ...
... The safety of this programme has been recently documented in large cohort studies [15,24]. This type of LF, generally lasting from 4 to 21 days, has been studied in various clinical conditions: chronic inflammatory disorders [92,93] and rheumatoid arthritis [59,94], hypertension [95], irritable bowel syndrome [96], insulin resistance, type 2 diabetes and metabolic syndrome [97,98], fibromyalgia [99], breast and ovarian cancer [100], osteoarthritis [101], obesity [102], and fatty liver [103]. Furthermore, MRI evaluation documented significant changes in body composition after 14 days of fasting [104]. ...
In recent years a revival of interest has emerged in the health benefits of intermittent fasting and long-term fasting, as well as of other related nutritional strategies. In addition to meal size and composition a new focus on time and frequency of meals has gained attention. The present review will investigate the effects of the main forms of fasting, activating the metabolic switch from glucose to fat and ketones (G-to-K), starting 12–16 h after cessation or strong reduction of food intake. During fasting the deactivation of mTOR regulated nutrient signalling pathways and activation of the AMP protein kinase trigger cell repair and inhibit anabolic processes. Clinical and animal studies have clearly indicated that modulating diet and meal frequency, as well as application of fasting patterns, e.g. intermittent fasting, periodic fasting, or long-term fasting are part of a new lifestyle approach leading to increased life and health span, enhanced intrinsic defences against oxidative and metabolic stresses, improved cognition, as well as a decrease in cardiovascular risk in both obese and non-obese subjects. Finally, in order to better understand the mechanisms beyond fasting-related changes, human studies as well as non-human models closer to human physiology may offer useful clues.
• KEY-MESSAGES
• Biochemical changes during fasting are characterised by a glucose to ketone switch, leading to a rise of ketones, advantageously used for brain energy, with consequent improved cognition.
• Ketones reduce appetite and help maintain effective fasting.
• Application of fasting patterns increases healthy life span and defences against oxidative and metabolic stresses.
• Today’s strategies for the use of therapeutic fasting are based on different protocols, generally relying on intermittent fasting, of different duration and calorie intake.
• Long-term fasting, with durations between 5 and 21 days can be successfully repeated in the course of a year.
... Food and dietary factors play a major role in the pathogenesis of symptoms in FBDs and are proposed to interact with our intestinal and colonic epithelia via the following: immune-mediated reactions, stimulation of the enteric nervous system (ENS) through chemical stimuli, luminal distention through mechanical forces, and unknown mechanisms [17]. The clear involvement of dietary factors in symptom generation in some individuals has been demonstrated by periods of fasting, which have been shown to reduce symptoms of abdominal pain and discomfort, bloating, and diarrhoea in those with IBS [18]. ...
Functional bowel disorders (FBDs) affect around 20% of the population worldwide and are associated with reduced quality of life and high healthcare costs. Dietary therapies are frequently implemented to assist with symptom relief in these individuals, however, there are concerns regarding their complexity, restrictiveness, nutritional adequacy, and effectiveness. Thus, to overcome these limitations, a novel approach, the 5Ad Dietary Protocol, was designed and tested for its efficacy in reducing the severity of a range of gastrointestinal symptoms in 22 subjects with FBDs. The protocol was evaluated in a repeated measures MANOVA design (baseline week and intervention week). Measures of stool consistency and frequency were subtyped based on the subject baseline status. Significant improvements were seen in all abdominal symptom measures (p < 0.01). The effect was independent of body mass index (BMI), age, gender, physical activity level, and whether or not the subjects were formally diagnosed with irritable bowel syndrome (IBS) prior to participation. Stool consistency and frequency also improved in the respective contrasting subtypes. The 5Ad Dietary Protocol proved to be a promising universal approach for varying forms and severities of FBDs. The present study paves the way for future research encompassing a longer study duration and the exploration of underlying physiological mechanisms.
... Women from developed countries are 2-4 times more likely to have IBS than men [91,92]. A study in Japan shows fasting (1-2 L of fluid each day, along with some nutrition through their vein) improves pain, discomfort, abdominal distension, diarrhea, anorexia, nausea and anxiety in IBS [93]. But breakfast is strictly recommended along with regular meal pattern in patients with IBS-C because it stimulates colon and increase bowel movement [94,95]. ...
... Skipping breakfast adversely affects menstrual disorders as reported in 2 different studies in young college students of Japan and Palestine [88][89][90]. Women from developed countries are 2-4 times more likely to have IBS than men [91,92]. ...
Breakfast, the first meal of the day, is considered the most important meal throughout the day. As nutritionist Adelle Davis famously put it back in the 1960s: “Eat breakfast like a king, lunch like a prince and dinner like a pauper”. Breakfast is most commonly skipped meal more than lunch and dinner specifically in the young adult in the university study period and those who wake up late. Lack of time is the main reason behind skipping meals, in general, lack of appetite, inability to cook, fasting/religion, and not being hungry. Many people are used to be in a hurry for job, business, children’s’ school in the morning where a filled stomach may prevent them to walk a long way. It is obvious that the irregular omission of breakfast may be effective in energy intake reduction over the next 24 hours and in this day, exercise performance may be compromised. There is no evidence that breakfast skipping reduces overeating or prevent weight gain. Some people argue that breakfast and good health is a marketing strategy by breakfast companies.
... Women from developed countries are 2-4 times more likely to have IBS than men [91,92]. A study in Japan shows fasting (1-2 L of fluid each day, along with some nutrition through their vein) improves pain, discomfort, abdominal distension, diarrhea, anorexia, nausea and anxiety in IBS [93]. But breakfast is strictly recommended along with regular meal pattern in patients with IBS-C because it stimulates colon and increase bowel movement [94][95]. ...
Breakfast, the first meal of the day, is considered the most important meal throughout the day. As nutritionist Adelle Davis famously put it back in the 1960s: "Eat breakfast like a king, lunch like a prince and dinner like a pauper". Breakfast is most commonly skipped meal more than lunch and dinner specifically in the young adult in the university study period and those who wake up late. Lack of time is the main reason behind skipping meals, in general, lack of appetite, inability to cook, fasting/religion, and not being hungry. Many people are used to be in a hurry for job, business, children's school in the morning where a filled stomach may prevent them to walk a long way. It is obvious that the irregular omission of breakfast may be effective in energy intake reduction over the next 24 hours and in this day, exercise performance may be compromised. There is no evidence that breakfast skipping reduces overeating or prevent weight gain. Some people argue that breakfast and good health is a marketing strategy by breakfast companies.
... It has been reported that NAG is a highly safe compound and intravenous injection of NAG (20 g) to the human body has no toxic effect and does not alter the blood glucose concentrations (Levin et al., 1961). Therefore, NAG is safely used as a nutritional supplement to treat diseases such as inflammatory bowel disease and osteoarthritis (Talent and Gracy, 1996;Kanazawa and Fukudo, 2006). On the other hand, there are many human pathogens such as P. aeruginosa, S. marcescens and V. cholera, which utilize QS to regulate their virulence activity (Zhu et al., 2002;Wei and Lai, 2006;Jimenez et al., 2012). ...
Bacteria communicate with one another and regulate their pathogenicity through a phenomenon known as quorum sensing (QS). When the bacterial colony reaches a threshold density, the QS system induces the production of virulence factors and the formation of biofilms, a powerful defence system against the host’s immune responses. The glucosamine monomer has been shown to disrupt the bacterial QS system by inhibiting autoinducer (AI) signalling molecules such as the acyl-homoserine lactones (AHLs). In this study, the synthesis of acetoxy-glucosamides 8, hydroxy-glucosamides 9 and 3-oxo-glucosamides 12 was performed via the 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride (EDC·HCl) and N,N'-dicyclohexylcarbodiimide (DCC) coupling methods. All of the synthesised compounds were tested against two bacterial strains, P. aeruginosa MH602 (LasI/R-type QS) and E. coli MT102 (LuxI/R-type QS), for QS inhibitory activity. The most active compound 9b showed 79.1% QS inhibition against P. aeruginosa MH602 and 98.4% against E. coli MT102, while compound 12b showed 64.5% inhibition against P. aeruginosa MH602 and 88.1% against E. coli MT102 strain at 2 mM concentration. The ability of the compounds to inhibit the production of the virulence factor pyocyanin and biofilm formation in the P. aeruginosa (PA14) strain was also examined. Finally, computational docking studies were performed with the LasR receptor protein.
... They are particularly effective in reducing bloating and flatulence, though there is little evidence for using any particular strain 22,32 . Fasting gives the gut time to recover from the damage caused by ingested materials by improving gut permeability 34 . ...
In this review of Sanskrit translations in traditional Ayurveda texts studies on skin and gut health we consider the integration of complementary and alternative medicine (CAM) with biomedicine (BM). We focus on irritable bowel syndrome (IBS) as a problem affecting 22% of the population with multiple known causes and unresponsive to biomedical and CAM intervention, but for which integrated medicine (IM) might be more useful. As up to 80% of medical patients concurrently use CAM alongside BM, it is imperative that doctors are able to understand and discuss its use with patients. In order to facilitate these therapeutic combinations, we must identify safe and effective CAM treatment protocols for their administration. CAM offers many treatment options, especially for IBS; however, its presentation can prove a barrier to understanding these options. Here, we consider the example of Ayurveda: a traditional Indian system of medicine in which derangements of the digestive system are well described but with unclear English translations. Forceful language and opinions are sometimes used to support traditional medicine. These unscientific obstacles detract from the multitude of treatment options CAM provides. If CAM were presented in a more scientific manner, modern medical practitioners would take IM more seriously. Research of CAM often lacks scientific rigour, leaving questions regarding its evidence base. Moreover, CAM literature does not utilize advances in the understanding of disease and epidemiology. BM has been less successful at disease prevention and managing chronic conditions while CAM focuses on optimizing health, even in the absence of obvious pathology. Patients are now more focused on health optimization leading to increased uptake of CAM. The onus is on us as health professionals to make sure that they are able to do this as safely and effectively as possible.
... It has been reported that NAG is a highly safe compound and intravenous injection of NAG (20 g) to the human body has no toxic effect and does not alter the blood glucose concentrations (Levin et al., 1961). Therefore, NAG is safely used as a nutritional supplement to treat diseases such as inflammatory bowel disease and osteoarthritis (Talent and Gracy, 1996;Kanazawa and Fukudo, 2006). On the other hand, there are many human pathogens such as P. aeruginosa, S. marcescens and V. cholera, which utilize QS to regulate their virulence activity (Zhu et al., 2002;Wei and Lai, 2006;Jimenez et al., 2012). ...
N-acetyl glucosamine, the monomer of chitin, is an abundant source of carbon and nitrogen in nature as it is the main component and breakdown product of many structural polymers. Some bacteria use N-acyl-L-homoserine lactone (AHL) mediated quorum sensing (QS) to regulate chitinase production in order to catalyze the cleavage of chitin polymers into water soluble N-acetyl-D-glucosamine (NAG) monomers. In this study, the impact of NAG on QS activities of LuxR, LasR, and CviR regulated gene expression was investigated by examining the effect of NAG on QS regulated green fluorescent protein (GFP), violacein and extracellular chitinase expression. It was discovered that NAG inhibits AHL dependent gene transcription in AHL reporter strains within the range of 50–80% reduction at low millimolar concentrations (0.25–5 mM). Evidence is presented supporting a role for both competitive inhibition at the AHL binding site of LuxR type transcriptional regulators and catabolite repression. Further, this study shows that NAG down-regulates CviR induced violacein production while simultaneously up-regulating CviR dependent extracellular enzymes, suggesting that an unknown NAG dependent regulatory component influences phenotype expression. The quorum sensing inhibiting activity of NAG also adds to the list of compounds with known quorum sensing inhibiting activities.
... Studies have shown that fermentable carbohydrates could increase colonic gas production, small intestinal water volume, and small intestinal motility and thus exacerbate IBS symptoms like pain, bloating, and diarrhea. In fact, fasting and diets restricted in fermentable carbohydrates were demonstrated to improve gastrointestinal symptoms including pain, bloating, and diarrhea in patients with IBS [29][30][31] . Thus, significantly higher food avoidance in IBS-D patients could be result of self-or physicianadvised restriction to minimize these gastrointestinal symptoms. ...
To determine effect of irritable bowel syndrome (IBS) subtype on IBS-specific quality of life (QOL) questionnaire and its subscales.
We studied IBS patients visiting our functional gastroenterology disorder clinic at a tertiary care center of Unites States. IBS and IBS subtype were diagnosed using Rome-III questionnaire. QOL was assessed using IBS-QOL questionnaire. IBS-QOL assesses quality of life along eight subscales: dysphoria, interference with activities, body image, health worry, food avoidance, social reactions, sexual health, and effect on relationships. IBS-QOL and its subscales were both scored on a range of 0-100 with higher scores suggestive of better QOL. Results of overall IBS-QOL scores and subscale scores are expressed as means with 95%CI. We compared mean IBS-QOL score and its subscales among various IBS-subtypes. Analysis of variance (ANOVA) was used to compare the mean difference between more than two groups after controlling for age and gender. A post-hoc analysis using Bonferroni correction was used only when P value for ANOVA was less than 0.05.
Of 542 patients screened, 243 had IBS as per Rome-III criteria. IBS-mixed (IBS-M) was the most common IBS subtype (121 patients, 49.8%) followed by IBS- diarrhea (IBS-D) (56 patients, 23.1%), IBS-constipation (IBS-C) (54 patients, 22.2%) and IBS-unspecified (IBS-U) (12 patients, 4.9%). Overall IBS-QOL scores were significantly different among various IBS-subtypes (P = 0.01). IBS-QOL of patients with IBS-D (61.6, 95%CI: 54.0-69.1) and IBS-M (63.0, 95%CI: 58.1-68.0) was significantly lower than patients with IBS-C (74.5, 95%CI: 66.9-82.1) (P = 0.03 and 0.02 respectively). IBS-D patients scored significantly lower than IBS-C on food avoidance (45.0, 95%CI: 34.8-55.2 vs 61.1, 95%CI: 50.8-71.3, P = 0.04) and interference with activity (59.6, 95%CI: 51.4-67.7 vs 82.3, 95%CI: 74.1-90.6, P < 0.001). IBS-M patients had more interference in their activities (61.6, 95%CI: 56.3-66.9 vs 82.3, 95%CI: 74.1-90.6, P = 0.001) and greater impact on their relationships (73.3, 95%CI: 68.4-78.2 vs 84.7, 95%CI: 77.2-92.2, P = 0.02) than IBS-C patients. Patients with IBS-M also scored significantly lower than IBS-C on food avoidance (47.2, 95%CI: 40.7-53.7 vs 61.1, 95%CI: 50.8-71.3, P = 0.04) and social reaction (66.1, 95%CI: 61.1-71.1 vs 80.0, 95%CI: 72.1-87.7, P = 0.005).
IBS-D and IBS-M patients have lower IBS-QOL than IBS-C patients. Clinicians should recognize food avoidance, effects on daily activities and relationship problems in these patients.
... El ayuno representa unas vacaciones para el tracto gastrointestinal y el sistema inmunitario, constatándose algunos resultados en la enfermedad inflamatoria del intestino. En un estudio de cohortes durante un ayuno de Ramadán se vio que el ayuno les sentaba muy bien a los pacientes que lo realizaron (47), observándose también mejoría en el colon irritable (48). ...
Voluntary fasting restricting solid foods are practiced around the world, traditional, cultural or religious reasons, and every day more therapeutic efficacy studies appear in the treatment of diseases. in this article we have tried to make a review of the therapeutic proposals found in the medical literature.
... Importantly, patients with IBS often report worsening of symptoms following food intake, 3 and fasting may relieve the symptoms. 4 Hence, perceived food intolerance is common, 5 and food has recently been denoted as 'the forgotten factor' in IBS. 6 Foods containing poorly absorbable, but fermentable carbohydrates seem to be particularly incriminated, and emerging evidence supports a role of FODMAP (fermentable oligo-, di-and monosaccharides and polyols) in IBS symptom generation. ...
Background
Postprandial discomfort following intake of poorly absorbable, but fermentable carbohydrates is a common complaint in patients with irritable bowel syndrome (IBS). We used lactulose as a model substance for this group of symptom triggering carbohydrates, aiming to visualize the intestinal response in IBS patients compared to healthy controls.Methods
Patients with IBS according to Rome III criteria (n = 52) and healthy controls (n = 16) underwent a lactulose challenge test. By using magnetic resonance imaging, we measured small bowel water content (SBWC), and distension (diameter) of the distal ileum and the colon, both in fasting state and 1 h after ingestion of 10 g lactulose. We recorded symptoms after lactulose ingestion.Key ResultsLactulose provoked significantly more symptoms in IBS patients than in healthy controls (p < 0.0001). SBWC increased more in the patient group compared to the control group (p = 0.0005). The postprandial diameter of the terminal ileum was larger in patients with IBS and the postprandial diameter of the ascending colon was smaller in patients with diarrhea-predominant phenotype (IBS-D). Symptoms were not correlated with change in SBWC (r = 0.05; p = 0.11), nor to the diameters of the terminal ileum or the colon.Conclusions & InferencesCompared to healthy controls, IBS patients developed more symptoms and had an abnormal accumulation of fluid in the small bowel in response to ingestion of the unabsorbable carbohydrate lactulose. This may be due to impaired motor activity of the small intestine or impaired function of the ileocecal segment.
... Up to 60 % of IBS patients report postprandial worsening of their symptoms: 28 % within 15 minutes of eating and 93 % within 3 hours [9,10]. Merely fasting itself can improve many symptoms associated with IBS, including abdominal pain, distension, and diarrhea [11]. Up to 90 % of patients report being able to identify one or more trigger foods and thus restrict their diet in an effort to minimize their symptoms [5,12]. ...
Opinion statement:
The medical community has only recently started to focus attention on the role of food in the pathogenesis of irritable bowel syndrome (IBS), though the association between food and gastrointestinal (GI) symptoms has been recognized by patients for decades. Health care providers receive little formal training in the dietary management of IBS and have traditionally viewed dietary interventions with skepticism. There is mounting evidence that links food to changes in motility, visceral sensation, microbiome, permeability, immune activation, and brain-gut interactions-all key elements in the pathogenesis of IBS. The role of specific dietary modification in the management of IBS has not been rigorously investigated until recently. There is now credible evidence suggesting that targeted dietary carbohydrate exclusion provides clinical benefits to IBS patients. There is emerging evidence to suggest that proteins such as gluten, as well as food chemicals, may play a role in IBS.
... Food elimination diets or prolonged fasting may reduce symptoms to some degree. [14][15][16][17] Such patients may undergo tests to exclude malabsorption and to identify the underlying cause. When standard testing for celiac disease, Crohn disease, and microscopic colitis is negative, physicians may assume the patient is suffering a form of functional diarrhea or irritable bowel syndromediarrhea, and the therapeutic options offered are limited, often to the current mainstream treatments used in irritable bowel syndrome-diarrhea ( Table 2). ...
... Bloating, a common symptom, is typically gone in the morning, but worsens during the day after eating. In the absence of food [15] , or when eating welltolerated food items only, bloating is much less pronounced . Some of the patients (19%) had on their own initiative started and continued with a glutenfree diet. ...
Patients with perceived food hypersensitivity typically present with multiple health complaints. We aimed to assess the severity of their intestinal and extra-intestinal symptoms.
In a prospective study, 84 patients referred to our outpatient clinic for investigation of perceived food hypersensitivity were enrolled consecutively. Irritable bowel syndrome (IBS) was diagnosed according to the Rome III criteria. Severity and impact of bowel symptoms, fatigue and musculoskeletal pain were evaluated by using the following questionnaires: The IBS Severity Scoring System (IBS-SSS), the Fatigue Impact Scale (FIS), the FibroFatigue Scale (FFS), and visual analogue scales (VAS) for scoring of musculoskeletal pain.
All but one patient were diagnosed with IBS, 58% with severe symptoms. Extra-intestinal symptoms suggestive of chronic fatigue and fibromyalgia were demonstrated in 85% and 71%, respectively. Neither IgE-mediated food allergy nor organic pathology could explain the patients' symptoms. Nevertheless, malabsorption of fat was demonstrated in 10 of 38 subjects.
Perceived food hypersensitivity may be associated with severe, debilitating illness. The comorbid triad of IBS, chronic fatigue, and musculoskeletal pain is striking and may point to a common underlying cause.
... IBD is a generic diagnosis that encompasses a number of bowel diseases, including ulceracolitis, chronic proctitis and Crohn's disease. IBD can involve the inflammatory disruption of vascular and matrix GAGs, and tumor necrosis factor-α appears to play an important role in inflammation110111112. The loss of GAGs from the intestinal wall results in fibrosis of the bowel. ...
N-Acetylglucosamine (GlcNAc) is a monosaccharide that usually polymerizes linearly through (1,4)-β-linkages. GlcNAc is the monomeric unit of the polymer chitin, the second most abundant carbohydrate after cellulose. In addition to serving as a component of this homogeneous polysaccharide, GlcNAc is also a basic component of hyaluronic acid and keratin sulfate on the cell surface. In this review, we discuss the industrial production of GlcNAc, using chitin as a substrate, by chemical, enzymatic and biotransformation methods. Also, newly developed methods to obtain GlcNAc using glucose as a substrate in genetically modified microorganisms are introduced. Moreover, GlcNAc has generated interest not only as an underutilized resource but also as a new functional material with high potential in various fields. Here we also take a closer look at the current applications of GlcNAc, and several new and cutting edge approaches in this fascinating area are thoroughly discussed.
In Deutschland hat das Fasten eine lange Tradition. Viele der Pioniere des therapeutischen Fastens kommen aus dem deutschsprachigen Raum. In der Medizin wurde das therapeutische Fasten lange Zeit unterschätzt und daher als nebenwirkungsfreie Maßnahme vernachlässigt. Die derzeitig vorliegenden wissenschaftlichen Daten lassen erkennen, dass therapeutisches Fasten als eine effektive und kostengünstige Alternative bei einer Vielzahl von Beschwerden öfter zur Anwendung kommen sollte. Der Wunsch der Patienten nach natürlichen Behandlungsmethoden kommt diesem Anspruch entgegen.
Aging is a universal process, in that all human beings age; however, the definition of aging is not universal. Views of the aging process vary across geographic space and cultural traditions. Differences between Western and Eastern cultural practices are some of the most well documented views of aging. Less obvious are the differences in social status and how wise aged populations are considered in various cultures.
Fasting has been practiced since ancient times for religious, spiritual, physical, and psychological purposes. It is conventionally believed that fasting has great rejuvenative effects on the body and mind. It helps deplete morbid matter from the body and so helps in regaining optimum health by reducing efforts to manage the abundance in store. Ancient Indian scriptures refer to fasting (known as vrata or upvasa) and document its benefits. As a biological phenomenon in the procurement of health, the avoidance of food is also seen in the wild.
This chapter discusses the historical perspectives, objectives, and physiology of fasting and explores its importance and benefits in various dimensions, both in empirical terms and through the evidence accumulated in the contemporary literature.
It is observed that, despite the considerable scientific exploration of the effects of fasting, it remains poorly understood and hence is poorly utilized as a therapeutic modality. Therefore, more studies are required to establish the role of therapeutic fasting as a noninvasive and evidence-based modality in the management of various lifestyle and psychosomatic illnesses for its ultimate scientific validation and subsequent application.
The pharmaceutically important compound N-acetylglucosamine (NAG) is used in various therapeutic formulations, dietary supplements, and in cosmetics. The aim of this study is to evaluate the agroindustrial waste sugarcane molasses as a carbon source for cell growth and production of NAG by the novel strain B. alvei NRC-14. Flaked α-chitin was used along with sugarcane molasses as carbon sources for production of NAG. The strain showed the greatest growth and production of NAG in presence of 6 g/L flaked α-chitin along with 4% of sugarcane molasses. Addition of sugarcane molasses to the growth medium actually allowed obvious increase in growth and NAG production by the strain than it did when flaked α-chitin was used alone. The results indicated that molasses does support the bacterial growth and the level of response being dependant on the concentration of molasses. The production of NAG with sugarcane molasses at 2 and 4% did not significantly differ. However, higher concentration of sugarcane molasses as well as the alkaline pH of growth medium decreased the yield of NAG. These results suggest the potential of sugarcane molasses for increasing growth and the effective bioconversion of flaked α- chitin into N-acetylglucosamine by the strain.
Das Reizdarmsyndrom zahlt zu den funktionellen Magen-Darm-Erkrankungen. Als typische Symptome treten Stuhlunregelmasigkeiten, Obstipation, Diarrho, Meteorismus und Schmerzen auf, die Lebensqualitat der Patienten ist haufig sehr eingeschrankt. Die Genese der Erkrankung ist multifaktoriell, eine kausale und damit kurative Therapie besteht bis heute nicht. Der Autor gibt auf Basis der Leitlinienempfehlungen eine Ubersicht zu den Moglichkeiten der integrativen Behandlung.
In the USA, it is estimated that between 25 and 55�million individuals are affected by irritable bowel syndrome (IBS), and, as in the UK, almost half of patients presenting with gastrointestinal symptoms are diagnosed with IBS (IBS Register, 2009). With no consensus as to the cause, management tends to focus on the relief of symptoms, often through ineffective pharmacological interventions. Topaz J Holloway argues that health professionals need to understand the limitations of using pharmacological therapy to relieve symptoms. Additionally, it seems rational for health professionals to seek to understand their patients′ ′culture′ in order to address what may well be the root cause of IBS-our modern day lifestyles.
Periods of deliberate fasting with restriction of solid food intake are practiced worldwide, mostly based on traditional, cultural or religious reasons. There is large empirical and observational evidence that medically supervised modified fasting (fasting cure, 200-500 kcal nutritional intake per day) with periods of 7-21 days is efficacious in the treatment of rheumatic diseases, chronic pain syndromes, hypertension, and metabolic syndrome. The beneficial effects of fasting followed by vegetarian diet in rheumatoid arthritis are confirmed by randomized controlled trials. Further beneficial effects of fasting are supported by observational data and abundant evidence from experimental research which found caloric restriction and intermittent fasting being associated with deceleration or prevention of most chronic degenerative and chronic inflammatory diseases. Intermittent fasting may also be useful as an accompanying treatment during chemotherapy of cancer. A further beneficial effect of fasting relates to improvements in sustainable lifestyle modification and adoption of a healthy diet, possibly mediated by fasting-induced mood enhancement. Various identified mechanisms of fasting point to its potential health-promoting effects, e.g., fasting-induced neuroendocrine activation and hormetic stress response, increased production of neurotrophic factors, reduced mitochondrial oxidative stress, general decrease of signals associated with aging, and promotion of autophagy. Fasting therapy might contribute to the prevention and treatment of chronic diseases and should be further evaluated in controlled clinical trials and observational studies. © 2014 S. Karger GmbH, Freiburg.
Background: Self-reported food hypersensitivity remains unexplained in most cases. Abdominal symptoms, typically consistent with the irritable bowel syndrome (IBS), are common in patients with such unexplained, self-reported food hypersensitivity. The etiology is obscure. Aim: The overall objective of the present study was to investigate possible mechanisms of postprandial abdominal symptom generation. A main purpose was to explore whether and how ingestion of low-digestible carbohydrates act as abdominal symptom triggers in patients with unexplained, self-reported food hypersensitivity. Main results: The findings can be summarized as follows: In study I, fructose-sorbitol malabsorption evoked more symptoms in patients with unexplained, self-reported food hypersensitivity than in healthy controls. Alterations in intestinal gas production and secretion of so-called ileal brake hormones (glucagon-like peptide 1 (GLP-1) and peptide YY (PYY)) could not be demonstrated. In study II, serum levels of chromogranin A (CgA) were found to be lower in patients with unexplained, self-reported food hypersensitivity than in healthy controls. In study III, lactulose malabsorption evoked more symptoms in patients with unexplained, self-reported food hypersensitivity than in healthy controls. The symptoms could not be fully explained by symptom anticipation, because lactulose induced more symptoms than placebo (glucose). Associated alterations in intestinal gas production and rectal levels of prostaglandin E2 (PGE2) and microbial fermentation products could not be demonstrated. In study IV, mechanisms of diarrhoea in a mouse model of food allergy were investigated. Changes within the jejunum were demonstrated in the food allergic mice, with development of muscular hypocontractility, increased levels of cytokines IL-4 and IL-6 and high numbers of mast cells. In study V, fecal levels of short-chain fatty acids (SCFA) were investigated, and the profile was different between patients with unexplained, self-reported food hypersensitivity and healthy controls. Increased proportions of butyric acid were demonstrated in the patient group, particularly in individuals with severe symptoms. Conclusion: Taken together, the results suggest that intolerance to low-digestible carbohydrates plays an important role in abdominal symptom generation in patients with unexplained, self-reported food hypersensitivity. Disturbances of intestinal motility may contribute to gastrointestinal symptom development by increasing the amount of malabsorbed carbohydrates. Altered intestinal fermentation is a potential cause of the patients’ unexplained symptoms.
Un rôle de l’alimentation est suggéré par deux tiers des patients avec Syndrome de l’intestin irritable (SII). Les mécanismes en cause sont multiples: allergie vraie (rare) ou intolérance alimentaire, hypersensibilité au gluten (avec ou sans maladie coeliaque), effet des lipides (rétention de gaz ou modification de la sensibilité rectale), intolérance au lactose ou effet des FODMAPs (favorisant des fermentations). La prise de certains probiotiques et/ou des conseils diététiques adaptés peuvent parfois améliorer les symptômes. Malgré des évictions alimentaires fréquentes les carences nutritionnelles sont rares.
The fasting therapy (FT) was developed as novel and simple psychotherapy for psychosomatic diseases from our laboratory. FT consisted of 10 days of starvation with 5 days of re-feeding. FT requires an individual room in the health care utilization due to social isolation. Although FT has empirically been used in Japan, little has known about precise mechanisms on the efficacy of this treatment. However, there are some interesting findings to suggest that this treatment may be effective for functional gastrointestinal disorders. It was reported that FT brought not only reduction of physical symptoms but also improvement of psychological abnormalities in intractable patients with irritable bowel syndrome (IBS). Further studies should be needed to clarify this treatment can be one of powerful psychological treatments for functional gastrointestinal disorders and the other psychosomatic diseases.
The purpose of this literature review is to develop a thorough understanding of the research on food intolerance and its relationship to irritable bowel syndrome. Knowledge of the connection between the two conditions will assist allied healthcare professionals in working with patients to better manage their symptoms. Reduced healthcare costs may also result if patients are able to identify problematic foods and experience symptom improvement with diet changes. The review consists of an overview of food intolerance including prevalence, specific foods implicated including an in-depth review of research on bulk sweeteners, as well as methods of diagnosis. In addition, prevalence, specific foods associated with food intolerance in irritable bowel syndrome patients such as carbohydrates and lipids, nutritional consequences of food intolerance, and possible food-related methods of treatment including increased fiber intake are discussed. Finally, suggestions for future research and possible directions allied healthcare professionals can start with in assisting patients are provided.
A burden on both patients and the healthcare system, irritable bowel syndrome (IBS) is a prevalent condition that can result in high medical costs, frequent visits to the doctor, missed work, and anxiety and depression in the patient. This chronic disorder causes abdominal pain or discomfort and is characterized by abnormal defecation that presents mainly as either constipation or diarrhea symptoms. IBS associated with diarrhea (IBS-D) accounts for approximately one third of all IBS patients. IBS-D treatment can be confusing and frustrating for both the patient and the physician, complicated by the fact that a specific therapeutic algorithm has not been developed. Treatment options are widely varied, consisting of both nonpharmacologic (dietary changes) and pharmacologic (loperamide and alosetron) interventions. Furthermore, mounting evidence suggests a possible role for small intestinal bacterial overgrowth in the pathogenesis of IBS-D; thus, both antibiotics (such as rifaximin) and probiotics are frequently used to treat patients. Although all of these interventions elicit some measure of symptom response in a proportion of treated patients, there is no standard of care for the treatment of IBS-D. Thus, physicians would benefit from knowledge of all of the strategies used to treat IBS-D, in order to treat patients appropriately.
Recognition of food components that induce functional gut symptoms in patient's functional bowel disorders (FBD) has been challenging. Food directly or indirectly provides considerable afferent input into the enteric nervous system. There is an altered relationship between the afferent input and perception/efferent response in FBD. Defining the nature of food-related stimuli may provide a means of minimizing such an input and gut symptoms. Using this premise, reducing the intake of FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols)--poorly absorbed short-chain carbohydrates that, by virtue of their small molecular size and rapid fermentability, will distend the intestinal lumen with liquid and gas--improves symptoms in the majority of patients. Well-developed methodologies to deliver the diet via dietician-led education are available. Another abundant source of afferent input is natural and added food chemicals (such as salicylates, amines, and glutamates). Studies are needed to assess the efficacy of the low food chemical dietary approach. A recent placebo-controlled trial of FODMAP-poor gluten provided the first valid evidence that non-celiac gluten intolerance might actually exist, but its prevalence and underlying mechanisms require elucidation. Food choice via the low FODMAP and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for functional gut symptoms.
Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia.
A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement.
We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak.
This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS.
This review summarizes what is known about the effect of diet on irritable bowel syndrome (IBS) symptoms emphasizing data from randomized, controlled clinical trials. Studies suggest that IBS symptoms in one quarter of patients may be caused or exacerbated by one or more dietary components. Recent studies indicate that a diet restricted in fermentable, poorly absorbed carbohydrates, including fructose, fructans (present in wheat and onions), sorbitol, and other sugar alcohols is beneficial, but confirmatory studies are needed. Despite a long history of enthusiastic use, fiber is marginally beneficial. Insoluble fiber may worsen symptoms. Some patients with IBS, especially those with constipation, will improve with increased intake of soluble fiber. Prebiotic fibers have not been adequately tested. Daily use of peppermint oil is effective in relieving IBS symptoms. The usefulness of probiotics in the form of foods such as live-culture yogurt and buttermilk for IBS symptoms is not established. In clinical practice, it is very difficult to establish that a patient's symptoms result from an adverse reaction to food. A double blind placebo-controlled food challenge is the most reliable method, but it is not suitable for routine clinical use. A modified exclusion diet and stepwise reintroduction of foods or trials of eliminating classes of food may be useful.
In sheep like in rats 2 hr after feeding and in fasting dogs, the rate of passage of digesta along the small intestine is related to the migration of the myo-electric complexes (MMCs). The modifications of this basic common pattern and that of its two consecutive irregular and regular phases were related to changes in the flow of digesta in both the proximal and distal parts of the small intestine. A high flow rate in the jejunum is associated to an increase in duration of the phases of ISA and by supernumerary MMCs at this level. Normally at the ileal level, the flow of digesta was lower than in upper parts with an increase in retention time associated both with a slow migration of the complexes and the disappearance of about one third of them after traversing 60% of the length of the small bowel. These experiments suggest that the origin, propagation and frequency of the basic MMC pattern as well as the ratio of ISA to quiescence are operative factors involved in small intestine propulsive activity. The continuous spiking activity seen immediately after feeding in rats and dogs and the autonomous pattern of activity of the ileum during prolonged fasting in sheep represent extreme changes of the basic MMC pattern.
One hundred two patients with irritable bowel syndrome were studied in a controlled trial of psychological treatment involving psychotherapy, relaxation, and standard medical treatment compared with standard medical treatment alone. Patients were only selected if their symptoms had not improved with standard medical treatment over the previous 6 months. At 3 months, the treatment group showed significantly greater improvement than the controls on both gastroenterologists' and patients' ratings of diarrhea and abdominal pain, but constipation changed little. Good prognostic factors included overt psychiatric symptoms and intermittent pain exacerbated by stress, whereas those with constant abdominal pain were helped little by this treatment. This study has demonstrated that psychological treatment is feasible and effective in two thirds of those patients with irritable bowel syndrome who do not respond to standard medical treatment.
During prolonged starvation, brain energy requirements are covered in part by the metabolism of ketone bodies. It is unknown whether short-term starvation of a few days' duration may lead to reduced brain glucose metabolism due to the change toward ketone body consumption. In the present study we measured the cerebral metabolism of glucose and ketone bodies in nine healthy volunteers before and after 3.5 days of starvation. Regional glucose metabolism was measured by dynamic positron emission tomography using [18F]2-fluoro-2-deoxy-D-glucose. The mean value of K1* in gray and white matter increased by 12% (p < 0.05), whereas k2* and k3* were unchanged compared with control values. Regional glucose metabolism in cortical gray matter was reduced by 26% from 0.294 +/- 0.054 to 0.217 +/- 0.040 mumol g-1 min-1 (p < 0.001). White matter glucose metabolism decreased by 27% (p < 0.02). The decrease was uniform in gray and white matter with regional decreases ranging from 24 to 30%. A determination using Fick's principle confirmed the reduction in glucose metabolism yielding a decrease of 24% from 0.307 +/- 0.050 to 0.233 +/- 0.073 mumol g-1 min-1 (p < 0.05), whereas CBF did not change (0.57 +/- 0.07 vs. 0.57 +/- 0.06 ml g-1 min-1). The global net uptake of beta-hydroxybutyrate increased 13-fold from 0.012 +/- 0.024 to 0.155 +/- 0.140 mumol g-1 min-1 (p < 0.05). Net uptake of acetoacetate and net efflux of lactate and pyruvate did not change significantly during starvation. The present study shows that the human brain adapts to the changes in energy supply as early as 3 days following initiation of starvation, at which time ketone bodies account for approximately one-fourth of the cerebral energy requirements.
Weight gain is a frequent side effect of antipsychotic medication which has serious implications for a patient's health and well being. This study systematically reviews the literature on the effectiveness of interventions designed to control weight gain in schizophrenia.
A systematic search strategy was conducted of major databases in addition to citation searches. Study quality was rated.
Sixteen studies met the inclusion criteria. Five of eight pharmacological intervention studies reported small reductions in weight (<5% baseline body weight). All behavioural (including diet and/or exercise) interventions reported small reductions in, or maintenance of, weight.
Weight loss may be difficult but it is not impossible. Given the inconsistent results, the widespread use of pharmacological interventions cannot be recommended. Both dietary and exercise counselling set within a behavioural modification programme is necessary for sustained weight control.
Patients with irritable bowel syndrome (IBS) often feel they have some form of dietary intolerance and frequently try exclusion diets. Tests attempting to predict food sensitivity in IBS have been disappointing but none has utilised IgG antibodies.
To assess the therapeutic potential of dietary elimination based on the presence of IgG antibodies to food.
A total of 150 outpatients with IBS were randomised to receive, for three months, either a diet excluding all foods to which they had raised IgG antibodies (enzyme linked immunosorbant assay test) or a sham diet excluding the same number of foods but not those to which they had antibodies.
Primary outcome measures were change in IBS symptom severity and global rating scores. Non-colonic symptomatology, quality of life, and anxiety/depression were secondary outcomes. Intention to treat analysis was undertaken using a generalised linear model.
After 12 weeks, the true diet resulted in a 10% greater reduction in symptom score than the sham diet (mean difference 39 (95% confidence intervals (CI) 5-72); p = 0.024) with this value increasing to 26% in fully compliant patients (difference 98 (95% CI 52-144); p<0.001). Global rating also significantly improved in the true diet group as a whole (p = 0.048, NNT = 9) and even more in compliant patients (p = 0.006, NNT = 2.5). All other outcomes showed trends favouring the true diet. Relaxing the diet led to a 24% greater deterioration in symptoms in those on the true diet (difference 52 (95% CI 18-88); p = 0.003).
Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.
One hundred two patients with irritable bowel syndrome were studied in a controlled trial of psychological treatment involving psychotherapy, relaxation, and standard medical treatment compared with standard medical treatment alone. Patients were only selected if their symptoms had not improved with standard medical treatment over the previous 6 months. At 3 months, the treatment group showed significantly greater improvement than the controls on both gastroenterologists' and patients' ratings of diarrhea and abdominal pain, but constipation changed little. Good prognostic factors included overt psychiatric symptoms and intermittent pain exacerbated by stress, whereas those with constant abdominal pain were helped little by this treatment. This study has demonstrated that psychological treatment is feasible and effective in two thirds of those patients with irritable bowel syndrome who do not respond to standard medical treatment.
A functional gastrointestinal disorder may be defined as a variable contamination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. The IBS is a functional gastrointestinal disorder attributed to the intestines: with symptoms of abdominal pain; disturbed defaecation [urgency, straining, feeling of incomplete evacuation, altered stool form (consistency) and altered stool frequency/timing]; and bloatedness (distension). Functional gastrointestinal symptoms are prevalent in Western society, and cultural and psychological factors are important in determining the sub-group who seek medical attention. Our report sets out guidelines for the diagnosis of the IBS. We emphasise the importance of a careful history and a positive diagnosis, since there are no diagnostic physical findings and no diagnostic tests. It is a relapsing disorder troubling people over many years, yet there is no evidence that life expectancy is altered by the IBS. An initial positive diagnosis is a safe one and seldom needs revision. A change in the clinical picture may imply superimposition of another disorder. Given the prevalence of IBS, the disorder will often co-exist with asymptomatic organic disease (e.g. gallstones).
(1) A controlled, blind trial of ascorbic acid saturation, involving 40 male, chronic psychiatric patients, is described.
(2) Standardized (objective and subjective) psychological techniques were used to assess changes dependent upon ascorbic acid intake.
(3) A clinical state of subscurvy was found in these patients.
(4) Psychiatric patients are shown to have an unusually high demand for ascorbic acid.
(5) Statistically significant improvement in the depressive, manic and paranoid symptom-complexes, together with an improvement in overall personality functioning, was obtained following saturation with ascorbic acid.
(6) It is suggested that chronic psychiatric patients would benefit from the administration of ascorbic acid.
It has been well known in Japan that fasting therapy has an excellent effect on various kinds of psychosomatic diseases. From 1967 to 1977 the therapy was carried out on about 382 cases of psychosomatic diseases in our clinic with an efficacy rate of 87%. The following diseases were considered as suitable indications for the therapy; irritable colon, behavioral disturbance of eating, functional disorders of the G-I tract, neurocirculatory asthenia, labile hypertension, variable psychosomatic symptoms of puberty, conversion hysteria and many kinds of neurosis with somatic complaints. The mechanism of effectiveness of the therapy is discussed from the psychological and biological aspects. It is concluded that the regulating mechanisms of the autonomic nervous system and endocrine system may change the whole functioning of the body including the brain, resulting in a spontaneous deconditioning of maladaptive bodily and mental behavior and an improved homeostatic adjustment to life.
The Tohoku University method of fasting therapy was performed on 380 patients. The clinical results revealed an efficacy rate of 87%. With regard to psychosomatic diseases, irritable colon syndrome, neurocirculatory asthenia, mild diabetes mellitus, obesity and borderline hypertension were good indications for this therapy. In order to clarify the therapeutic mechanism, several clinical examinations were administered before, during and after therapy. EEG data was analysed according to the power spectral method. The peak frequency decreased as fasting progressed, while it increased as re-fed continued. Percent energy of alpha waves after fasting therapy was significantly higher than that of the pre-fasting stage. The dexamethasone suppression rate of urine 17-OHCS after fasting therapy was significantly lower than that of the pre-fasting stage. It seems that ketone nutrition may work as a strong stressor in the brain cell, temporarily placing all biological mechanisms in a stress state and then activating the natural healing power inherent to the human body, thereby bringing about homeostasis.
A questionnaire to establish the presence of 15 symptoms thought to be typical of the irritable bowel syndrome (IBS) was given to 109 unselected patients referred to gastroenterology or surgery clinics with abdominal pain or a change in bowel habit or both. Review of case records 17--26 months later established a definite diagnosis of IBS in 32 patients and of organic disease in 33. Four symptoms were significantly more common among patients with IBS--namely, distension, relief of pain with bowel movement, and looser and more frequent bowel movements with the onset of pain. Mucus and a sensation of incomplete evacuation were also common in these patients. The more of these symptoms that were present the more likely was it that the patient's pain or altered bowel habit, or both, was due to IBS. We conclude that a careful history can increase diagnostic confidence and reduce the amount of investigation in many patients with chronic abdominal pain.
It has been well known that the fasting therapy which was invented in Medical School of Tohoku University reveals an excellent effect upon various kinds of psychosomatic diseases, but its therapeutic mechanism and suitable indication are not yet explained completely. In order to corroborate these problems, this study was undertaken on 262 cases of psychosomatic diseases in the field of internal medicine. It is a complete fasting for 10 days with nothing by mouth except for drinking water, and 500 ml of parenteral fluid containing vitamins are administered intravenously every day. Absolute bed rest and self meditation are required in a closed individual room, and patients are not allowed to meet anyone but physicians and nurse in charge. The return to normal ordinary diet follows the order of fluid diet, soft diet and semiordinary diet during 5 days. In the period of the therapy, various clinical and laboratory examinations were carried out. Significance of these examinations consists in prediction of possible danger during the fasting period and elucidation of its therapeutic mechanism. Consequently, an outstanding efficacy rate of 87% with excellent prognosis was attained, and the following diseases were determined as suitable indication of this therapy; irritable colon, dysorexia nervosa, borderline hypertension, neurocirculatory asthenia, bronchial asthma, mild diabetes mellitus, obesity, lumbago without organic findings, conversion hysteria, various neurosis with somatic symptoms and masked depression. Possible mechanism of action of the therapy is that fasting acts as an extreme stress on the function of the autonomic nervous and endocrine systems, then it regulates the function of whole body including the brain, also it acts as one of the behaviour therapy for abnormal conditioning.
Otherwise healthy and well-nourished patients with rheumatoid arthritis show significant clinical improvement from practising prolonged fasting for 7 to 10 days. The improvement is reversible and lost when eating is taken up again. Although of little therapeutic value, the anti-inflammatory effect of short-term fasting is of significant interest and better understanding of the mechanisms is desirable.
AND CONCLUSIONS
Among medical clinic patients consulting for IBS, symptoms of psychologic distress are common, and more than half of these patients are found to have a psychiatric diagnosis in addition to bowel dysfunction. Many investigators have therefore concluded that IBS is a psychophysiologic disorder and proposed that patients with IBS be treated with psychologic techniques. However, recent studies suggest that this association may be spurious; persons in the community who have symptoms of IBS but do not consult a doctor have no more psychologic symptoms than persons without bowel symptoms. This indicates that psychologic symptoms do not cause bowel symptoms, but, instead, influence which persons with bowel symptoms will consult a physician.
The bowel symptoms and the psychologic symptoms that coexist in most patients with IBS may be best thought of as comorbid conditions. Neither causes the other, but both may be serious enough to warrant treatment. Moreover, in some patients whose bowel symptoms consist of vague complaints of abdominal pain not specifically related to defecation or to changes in the frequency or consistency of bowel habits, the psychologic disorder may be primary.
Psychologic stress may exacerbate IBS whether or not the patient has a psychiatric disorder, and psychologic stress may trigger acute episodes of symptoms similar to those of IBS even in persons without IBS. However, the magnitude of this correlation is modest, suggesting that only about 10% of the variation in bowel symptoms is attributable to stress.
Psychologically oriented treatments have a role in the management of IBS. Most patients who consult internists about bowel symptoms have significant levels of depression and anxiety, and they tend to notice and to worry about somatic complaints more when they experience these dysphoric affects. Psychologic treatments that reduce the level of their psychologic distress also frequently reduce the frequency and severity of complaints about bowel symptoms. Tricyclic antidepressants may be tried as a first line of treatment; they have been shown to be superior to placebo for the management of abdominal pain and diarrhea but not constipation. In patients who do not show an adequate response to antidepressants, brief psychotherapy focusing on better ways of coping with current problems, hypnosis, or behavior therapy emphasizing methods of controlling reactions to stress are recommended. Controlled trials show these treatment approaches to be superior to medical management alone.
It may appear paradoxical that psychologic treatments aimed at the management of emotions are so frequently found to reduce bowel symptoms, because the motility disorder responsible for the bowel symptoms may be unrelated to the psychologic symptoms that influence the patient to seek treatment. However, none of the studies that evaluate psychologic treatments for IBS used restrictive diagnostic criteria to select patients for inclusion. Instead, vague diagnostic criteria that reflect primarily a psychologic tendency to somatize were employed. The somatizing patient is the most likely to show a reduction in somatic symptoms in response to a psychologic intervention. Future studies of psychologic treatments for IBS should use more restrictive inclusion criteria.
To identify the effects of acute starvation on endogenous opioids in man, plasma beta-endorphin (beta-EP) was measured in 17 patients before, during and after fasting. Patients were assigned a posteriori into two groups: group A, comprised of 11 patients able to tolerate 5-7 days of fasting, and group B, comprised of 6 patients able to tolerate 10 days of fasting. Changes in plasma beta-EP, serum cortisol, circulating nutritional markers, and their relative levels were assessed on the 5th and 10th days of fasting, and on the 5th and 10th days of the refeeding period. Beta-EP had increased by the 5th day (group A: 4.74 +/- 0.42 to 6.91 +/- 0.65 pmol/l, p less than 0.01; group B: 3.60 +/- 0.48 to 5.14 +/- 0.22 pmol/l, p less than 0.05, and remained at 5.05 +/- 0.65 pmol/l on the 10th day (group B: 0.05 less than p less than 0.1) during fasting. Group B had lower levels of plasma beta-EP on the 5th day of fasting than group A (p less than 0.05). However, serum cortisol levels changed similarly in both groups. Plasma beta-EP showed no significant correlation with either the percentage of body weight lost or the body mass index (kg/m2) over this study period. These findings indicate that plasma beta-EP is elevated in the early phase of fasting, while not directly being associated with body weight changes. Plasma beta-EP is lower and less activated in subjects who are able to tolerate fasting for longer periods.
Data from six large, systematic national health surveys were examined to provide a more complete description of the epidemiology of irritable bowel syndrome in the United States. Data from the Second National Health and Nutrition Examination Survey, 1976-1980, indicated 4.7 million people (2.9% of the population) with self-reported diagnoses of irritable bowel syndrome. Rates for women were 3.2 times those for men, and rates for whites were 5.3 times those for blacks. Rates were highest among those aged 45-64 years. More than 2.6 million (1.6% of the population) were symptomatic at the time of the survey. Data from the National Ambulatory Medical Care Survey, 1985, and the National Disease and Therapeutic Index, 1987, documented between 2.4 and 3.5 million yearly visits to physicians by patients with irritable bowel syndrome and more than 2.2 million medications prescribed. Rates of hospitalization for women have fallen from 71.9 (per 100,000 population) in 1982 to 21.1 in 1987 based on data from the National Hospital Discharge Survey. A similar pattern was observed in data from the Commission on Professional and Hospital Activities. The data support the impression that irritable bowel syndrome is a prevalent condition in the United States with significant impact on health care. Large-scale, population-based surveys using standard criteria are needed to estimate the true extent of irritable bowel syndrome.
Fifty eight patients with the irritable bowel syndrome (IBS) have been investigated by skin-prick testing, quantitation of total serum IgE levels and determination of serum antibodies reactive with common dietary proteins. An increased incidence of skin reactivity (48.3 percent; p < 0.05), as well as serum IgG antibodies reactive with chicken ovalbumin, bovine milk or wheat gliadin (52.6 percent; p < 0.01), was demonstrated in IBS patients compared with controls. These results provide evidence of immunological hypersensitivity in at least a proportion of IBS subjects and contrasts with the concept that IBS always results from psychological factors.
Twenty-four subjects completed a study comparing the efficacy of a psychological treatment package suggested by Latimer (1983) and the best medical regime available in the treatment of the Irritable Bowel Syndrome (IBS). Initial anxiety levels were high in both groups and were reduced in the psychological, but not medical, condition. IBS symptoms and associated behaviours were reduced equally in both conditions.
: In a pilot study of the psychological and physiological effects of intermittent fasting (periods up to 80 days) in the reduction of superobese patients to normal weight, none of the depressive-inhibitory phenomena reported in starving normalweight humans was observed, although the patients were kept fully ambulatory. Episodes of anxiety and depression were observed but were related to problems with family members, the doctor-patient relationship, or disturbances in the ward milieu and not to fasting or weight loss. Although it can be concluded that starvation is not harmful--psychologically or physiologically--in the treatment of obesity, further studies are necessary to show how effective it may be in terms of lasting effects. Copyright (C) 1966 by American Psychosomatic Society
STUDIES AIMED at understanding the etiologic factors in hyperphagia and obesity fall into two major categories. One group includes many efforts to uncover a brain lesion, metabolic abnormality, or genetic variable which predisposes to corpulence. The second major group of investigations attempt to link obesity with emotional factors.
Among the psychological studies, a number of attempts have focused on emotional constellations which might have specific connections with obesity. One such association which has remained prominent in medical and psychiatric thinking has been that of obesity and depression.1-3 Obesity has been considered a defense against depression4 or a reaction to the specific mood of depression,5-7 and hyperphagia has been called a "depressive alibi."8
In recent years, this relationship between obesity and depression has come under greater scrutiny, partly because of the dilemma that it presents to the
Food hypersensitivity as a cause of abdominal symptoms was investigated by means of exclusion diets and double-blind food provocation in patients with irritable bowel syndrome. Twenty-seven patients entered the study; nineteen complied with dietary manipulation. Food hypersensitivity as a cause of their presenting symptoms was confirmed by double-blind food provocation in only three patients, who also had evidence of associated atopic disease and positive skin tests to common inhalant allergens. Evidence of minor psychiatric disorder was found in twelve of fourteen patients examined by an independent psychiatrist.
101 outpatients with irritable bowel syndrome were randomly allocated to two treatment groups. Both groups received the same medical treatment, but patients in one group also received dynamically oriented individual psychotherapy in ten hour-long sessions spread over 3 months. After 3 months there was a significantly greater improvement in somatic symptoms in the psychotherapy group. The difference became more pronounced a year later, with the patients given psychotherapy showing further improvement, and the patients who received medical treatment showing some deterioration. The combination of medical treatment with psychotherapy improves outcome, not only in the short term but also in the long run.
30 patients with severe refractory irritable-bowel syndrome were randomly allocated to treatment with either hypnotherapy or psychotherapy and placebo. The psychotherapy patients showed a small but significant improvement in abdominal pain, abdominal distension, and general well-being but not in bowel habit. The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the 3-month follow-up period, and no substitution symptoms were observed.
Three therapeutic modalities are defined in terms of the analyst's level of listening, formulating, intervening, validating, and relating. These are identified as working with (a) manifest contents, (b) Type One derivatives (isolated inferences from the patient's material), and (c) Type Two derivatives (material organized around the prevailing precipitant or adaptive context-as a rule, the analyst's attitude and interventions). The curative factors in the first two modes of therapy are conceptualized as barrier systems designed to seal off the most pertinent and chaotic truths within both patient and analyst. The curative elements in the third mode is seen in terms of dynamically truthful realizations providing access to the most compelling actualities, both conscious and unconscious, within the ongoing, spiralling communicative interaction between patient and analyst. The development of these ideas are traced out, and necessary concepts defined, and illustrations are drawn from the literature and discussed. The implications of these proposals are then considered.
The endogenous opiate alkaloid content in tissues from fed, 24 h and 48 h fasted rats was determined. Plasma morphine and codeine concentrations did not change in response to fasting. Morphine levels in the spleen increased 3-fold after 24 h of fasting and were lower than fed rats by 48 h of fasting; no change was detected in spleen codeine levels. Brain morphine levels were elevated 5-fold after 24 h of fasting and were two-fold higher than those of fed rats after 48 h of fasting. Brain codeine levels did not change with fasting. These results indicate that opiate alkaloids are endogenously produced in rodent tissues, particularly in the spleen, liver, and adrenals. The synthesis of morphine, in the spleen and brain, is maximally stimulated after 24 h of fasting, without alterations in tissue codeine synthesis. These suggest differential regulation of the endogenous synthetic pathways of morphine and codeine in response to the stress of fasting.
Computerized pharmacy records from a large staff-model health maintenance organization were used to examine patterns of antidepressant use by primary care physicians and psychiatrists. Based on timing of prescription refills, patients treated by psychiatrists were more likely than those treated in primary care to continue medication for more than 30 days (35% vs 25%, p < 0.00001) and more likely to reach a prescribed daily dose of 100 mg of imipramine or the equivalent (48% vs 40%, p < 0.00001). Patients treated with newer antidepressants were significantly more likely to continue treatment past 30 days (range from 75% for fluoxetine to 54% for doxepin, p < 0.00001) and to reach an adequate daily dose (range from 51% for fluoxetine to 26% for doxepin, p < 0.00001). Psychiatrists more often prescribed newer antidepressants, and much of the difference between specialties could be explained by drug selection. These findings suggest more intensive antidepressant treatment than in earlier reports, especially in primary care. More intensive treatment with newer antidepressants may reflect more tolerable side effects, but these observational data are liable to selection bias. Any potential advantages of newer antidepressant medications must be balanced against significantly higher costs.
We aimed to determine the efficacy of psychological treatments in irritable bowel syndrome.
A systematic review of the literature on psychological treatments of IBS was performed using Medline (1966-1994) and Psychlit (1974-1994) and secondary references. Fully published studies in English were selected if they compared any type of "psychological" treatment of irritable bowel syndrome with a control group. Studies without any comparable control group, studies in which the subject group was not confined to irritable bowel syndrome sufferers, and those in which irritable bowel syndrome symptoms were not the primary outcome measures were excluded. Each study was reviewed using a structured format to examine methodological issues. A quality algorithm was developed a priori based on eight key requirements.
Eight studies (57%) reported that a psychological treatment was superior to control therapy; five failed to detect a significant effect, and one did not report if psychological treatment was superior. By the quality algorithm, only one study (a hypnotherapy trial) exceeded the preset cutoff score of 6, but this study was poorly generalizable due to sample selection.
The efficacy of psychological treatment for irritable bowel syndrome has not been established because of methodological inadequacies; future trials need to address these design limitations.
One hundred and twenty young adult females took either a placebo or 50 mg thiamine, each day for 2 months. Before and after taking the tablets, mood, memory and reaction times were monitored. An improvement in thiamine status was associated with reports of being more clearheaded, composed and energetic. The taking of thiamine had no influence on memory but reaction times were faster following supplementation. These influences took place in subjects whose thiamine status, according to the traditional criterion, was adequate.
The association between the irritable bowel syndrome (IBS) and psychiatric disorders is well-known to most clinicians, but the nature of the relationship is far from clear. There is an increased prevalence of psychiatric illness in IBS patients and an increase in IBS in psychiatric patients. Whether this association exists outside of treatment-seeking populations (i.e., in IBS sufferers who do not seek treatment) has not been well investigated. This paper will selectively review the existing literature regarding the association of IBS and psychiatric illness in both patient and nonpatient samples. A model of the brain-gut interaction will be presented, as will practical implications of this model for treatment of individuals with IBS.
This article is divided into two parts, the first of which focuses on a general overview of irritable bowel syndrome (IBS) and provides a rationale for the use of cognitive-behavioral therapy (CBT) for IBS based on both theoretical and research perspectives. This section includes a critical review of CBT therapies for IBS and provides a model of CBT for IBS. The second section provides the clinician with practical information concerning the application of cognitive-behavioral group therapy for IBS. Possible scripts and case examples are incorporated into this section to highlight factors that may arise in working with IBS patients relative to other clinical groups. The second section also contains themes that are suggested content areas for group sessions. Contingent on the formulation of the presenting or emerging issues and goals, the order and inclusion of themes can be changed to fit the particular needs of a given group. Finally, this section provides initial preliminary data from a randomized controlled study that is suggestive of the efficacy of cognitive-behavioral therapy for IBS.
To summarise comparisons of randomised clinical trials and non-randomised clinical trials, trials with adequately concealed random allocation versus inadequately concealed random allocation, and high quality trials versus low quality trials where the effect of randomisation could not be separated from the effects of other methodological manoeuvres.
Systematic review.
Cohorts or meta-analyses of clinical trials that included an empirical assessment of the relation between randomisation and estimates of effect.
Cochrane Review Methodology Database, Medline, SciSearch, bibliographies, hand searching of journals, personal communication with methodologists, and the reference lists of relevant articles.
Relation between randomisation and estimates of effect.
Eleven studies that compared randomised controlled trials with non-randomised controlled trials (eight for evaluations of the same intervention and three across different interventions), two studies that compared trials with adequately concealed random allocation and inadequately concealed random allocation, and five studies that assessed the relation between quality scores and estimates of treatment effects, were identified. Failure to use random allocation and concealment of allocation were associated with relative increases in estimates of effects of 150% or more, relative decreases of up to 90%, inversion of the estimated effect and, in some cases, no difference. On average, failure to use randomisation or adequate concealment of allocation resulted in larger estimates of effect due to a poorer prognosis in non-randomly selected control groups compared with randomly selected control groups.
Failure to use adequately concealed random allocation can distort the apparent effects of care in either direction, causing the effects to seem either larger or smaller than they really are. The size of these distortions can be as large as or larger than the size of the effects that are to be detected.
We undertook to determine whether adverse food reactions play a role in irritable bowel syndrome (IBS).
A systematic review of the literature using Medline (1980-1996), targeting IBS and adverse food reactions, was performed. All clinical trials whereby dietary exclusion was followed by food challenge were selected. Each study was reviewed using a structured format to examine methodological issues and study outcomes.
Of the seven studies included, the positive response to an elimination diet ranged from 15% to 71%; double-blind placebo-controlled challenges identified problem foods in 6% to 58% of cases. Milk, wheat, and eggs were most frequently identified to cause symptom exacerbation; of the foods identified the most common trait was a high salicylate content. Foods high in amines were also identified. Studies of diarrhea-predominant IBS identified a higher percentage of adverse food reactions. However, all studies had major limitations in their trial designs, including inadequate patient selection, appropriateness of--and duration of--exclusion diets, and methods of food challenge.
Whether adverse reactions to foods are a key factor in exacerbating IBS symptoms or whether dietary manipulation is a valid treatment option is unclear. Carefully designed controlled clinical trials are now needed to specifically test the potential role of adverse food reactions in diarrhea-predominant IBS.
Sympathetic hyperactivity is one factor for alterations encountered in the plurimetabolic syndrome, a cluster of metabolic abnormalities including obesity, hyperlipidemia, sometimes hyperglycaemia, and hypertonia. It was interesting to know if prolonged severe underfeeding (230 kcal/day) leads to decreases in catecholamines in those patients.
The plasma concentrations of catecholamines in patients (n = 16) suffering from plurimetabolic syndrome were studied before and during a 16-day period of medically controlled severe underfeeding (230 kcal/day) at rest and in response to exercise.
During the period of underfeeding, mean norepinephrine concentrations decreased at rest from 1.45 to 0. 96 nmol/liter, and in response to exercise, from 6.1 to 3.2 nmol/liter. Epinephrine concentrations decreased from 0.15 to 0.1 nmol/liter and from 0.26 to 0.17 nmol/liter, respectively. A significant decrease in catecholamine concentrations was observed only after 16 days of underfeeding.
Clinically controlled underfeeding of patients with plurimetabolic syndrome may result in beneficial clinical and biochemical effects. The findings indicate that relatively long periods of underfeeding induce decreases in plasma catecholamine concentrations. Nevertheless, most of the fall in mean values in norepinephrine and also of the fall in blood pressure values occurred by Day 2. From those tendencies and from the significant changes in both parameters at Day 16 of severe underfeeding one could conclude that altered sympathetic nervous system activity could contribute to the fall in blood pressure.
Ascorbic acid (AA) modulates catecholaminergic activity, decreases stress reactivity, approach anxiety and prolactin release, improves vascular function, and increases oxytocin release. These processes are relevant to sexual behavior and mood.
In this randomized double-blind, placebo-controlled 14 day trial of sustained-release AA (42 healthy young adults; 3000 mg/day Cetebe) and placebo (39 healthy young adults), subjects with partners recorded penile-vaginal intercourse (FSI), noncoital partner sex, and masturbation in daily diaries, and also completed the Beck Depression Inventory before and after the trial.
The AA group reported greater FSI (but, as hypothesized, not other sexual behavior) frequency, an effect most prominent in subjects not cohabiting with their sexual partner, and in women. The AA but not placebo group also experienced a decrease in Beck Depression scores.
AA appears to increase FSI, and the differential benefit to noncohabitants suggests that a central activation or disinhibition, rather than peripheral mechanism may be responsible.
A significant proportion of IBS patients attribute their symptoms to adverse food reactions. Dietary elimination and re-challenge studies support the role of diet in the pathogenesis of IBS. The aetiopathogenesis of IBS is thought to be multifactorial involving an interaction between diet, infection, antibiotics and psychosocial factors. Serum IgE and IgG4 antibodies are elevated in food hypersensitivity induced atopic conditions and a similar mechanism has been postulated in IBS. Increased number of mast cells is present in the ileocaecal region of IBS patients. Once sensitized, they are capable of inducing secretory and sensorimotor abnormalities of the gut. The management of IBS is usually aimed at controlling symptoms, however, evaluation of food hypersensitivity may provide a useful adjunct in those with severe symptoms or a clear history of adverse food reaction. There are no well-established tests available but skin prick tests and food specific serum IgG4 and IgE antibodies may help in identifying the offending foods. Other options, which may be explored in individual cases, include sequential dietary exclusion, use of hypoallergenic diets, disodium cromoglycate and novel techniques such as colonoscopic allergen provocation test. Pathophysiology of hypersensitivity induced IBS has been discussed in the light of current data and a management algorithm has been proposed for managing food hypersensitivity in IBS.
The irritable bowel syndrome (IBS) is part of the larger group of functional gastrointestinal (GI) disorders that, despite differences in location and symptom patterns, share common features with regard to their motor and sensory physiology, central nervous system (CNS) relationships, and the approach to patient care.¹ IBS is a functional bowel disorder characterized by symptoms of abdominal pain or discomfort that is associated with disturbed defecation.² This disorder is highly prevalent and can be associated with significant emotional distress, impaired health-related quality of life (HRQL), disability, and high health care costs. Psychosocial factors, although not part of IBS per se, have an important role in modulating the illness experience and its clinical outcome.³
GASTROENTEROLOGY 2002;123:2108-2131
The aim of this study was to replicate and extend the findings of O'Connor, Bélanger, Marchand, Dupuis, Elie, and Boyer [Addict. Behav. 24 (1999) 537], which had established a psychosocial profile associated with psychological distress in benzodiazepine (BZD) use. Forty-one participants with anxiety or insomnia, receiving maintenance therapy of BZD for at least 8 weeks, participated in a 20-week, tapered discontinuation protocol with physician counselling. Drug type and use was monitored throughout. Questionnaire measures of anxiety, behavioural inhibition, neuroticism, withdrawal complaints, social support, psychological distress, self-efficacy in coping without BZD, quality of life, positive and negative life events, were completed at baseline, postdiscontinuation, and at 3-month follow-up. Measures of baseline psychological distress and anxiety inhibition were consistently associated with both discontinuation and the emergence of withdrawal complaints. Successful withdrawal was characterized by low baseline neuroticism, low behavioural inhibition, higher number of positive events, and higher level of social support satisfaction. Higher dosage (in diazepam equivalent dose) was associated with both poorer outcome and the emergence of withdrawal symptoms. Self-efficacy in coping was negatively associated with relapse but not with outcome. Psychosocial factors play a role at different stages of the BZD withdrawal process and could be targeted in treatment.
Little is known about the prevalence and risk factors for development of irritable bowel syndrome (IBS) in Japan. In the United States, it is reported that heredity and social learning contribute to the development of IBS. Our aims were (1) to estimate the prevalence of IBS, (2) to confirm that subjects with IBS are more likely to have parents with a history of bowel problems, (3) to confirm that gastroenteritis is a risk factor for IBS, and (4) to determine whether these two risk factors interact with psychological distress. Prevalence was estimated from a sample of 417 young adults seen for annual health screening examinations. To evaluate risk factors related to consulting physicians, the 46 subjects who fulfilled Rome II diagnostic criteria for IBS but denied ever having seen a physician about these symptoms (IBS non-consulters) were compared to the 317 subjects who did not meet the criteria for IBS (controls) and to a group of 56 patients diagnosed with IBS by gastroenterologists (IBS patients). All subjects completed the Gastrointestinal Symptoms Rating Scale, the State-Trait Anxiety Inventory, the Self-Rating Depression Scale, the Perceived Stress Scale, and the SF-36 quality of life scale. Fourteen and two-tenths percent (15.5% of females and 12.9% of males) of the community sample met the criteria for IBS diagnosis, of whom 22% consulted physicians. IBS patients and IBS nonconsulters were more likely than controls to have a parental history (33.9 vs. 12.6%, P
Psychoanalysis and psychoanalytic psychotherapy Comprehensive textbook of psychiatry
- R L Stewart