Your field guide to gut conditions
For a lot of people, gut conditions are easy to confuse with one another. So, let's navigate the differences between the most common gut disorders in the U.S.
Millions of Americans just don’t look forward to meals because eating causes pain and discomfort. The conditions that underlie these symptoms include syndromes, diseases, infections, and sensitivities.
Let’s get down to the details.
Celiac Disease
A lot of folks have difficulty digesting gluten. However, people with true celiac disease have a specific inflammatory response to gluten, a protein found in most grains. Affecting about one of one hundred people, it’s more common than most people realize.
When a person with celiac disease eats gluten, his or her immune system reacts, causing an inflammatory response that damages the villi of the small intestine—the fingerlike projections that absorb nutrients. People with celiac disease don’t just experience symptoms like bloating, gas, diarrhea, abdominal pain, fatigue, and weakness. Because their villi no longer function normally, they can’t get adequate nutrition from the foods they eat.
Children with the condition are often underweight, and both adults and children have low levels of vitamins and minerals in their bodies. Since their bodies cannot process gluten, they must completely avoid grains and any gluten-containing processed foods in order to control their symptoms and improve their nutritional status.
But what leads to Celiac Disease?
Unfortunately, about 80% of people who have it don’t know that they do and may have received a different diagnosis. It has a strong genetic component and tends to run in families. Most people with celiac disease experience different degrees of immediate reactions to accidently-ingested gluten. But there will be lingering dysfunction and inflammation no matter how minimal the initial reaction. It's always a good idea to keep some anti-inflammatory tools on hand, just in case.
Crohn's Disease
Crohn’s is considered an inflammatory bowel disease. The physical damage created by the body’s autoimmune attack differentiates it from other chronic gut conditions, especially Irritable Bowel Syndrome. Although the autoimmune reaction can generate inflammation anywhere along the digestive tract from the esophagus to the anus, the most frequent area affected is the terminal ileum, the connection between the small and large intestine. In severe cases, the inflammation can produce a fistula, or tunnel, in the lining of the digestive tract.
It’s estimated that nearly 800,000 Americans have this disease that causes a wide variety of symptoms, including chronic:
- abdominal pain
- loss of appetite,
- nausea,
- vomiting
- diarrhea
- rectal bleeding
- weight loss
- fever
Despite the chronic nature of Crohn’s, people who have it may enjoy long periods of remission. Some people find that avoiding trigger foods like dairy, fatty foods, carbonated beverages, alcohol, coffee, and raw fruits and vegetables can help them control their symptoms.
So, what leads to Crohn's?
The causes of Crohn’s Disease aren’t fully understood, but one theory is that a viral or bacterial infection could trigger an auto-immune response. Being related to someone who has it increases the likelihood that you’ll develop it, suggesting that genetics play a role as well. Although it can occur at any age, people in their twenties are most likely to develop Crohn’s. Smoking doubles your risk of Crohn’s and may increase its severity. Although NSAIDs (non-steroidal anti-inflammatory drugs) don’t cause Crohn’s, they can worsen inflammation and cause a flare-up for someone who is in remission. For many people with Crohn's, anti-inflammatory tools are key to self-management of daily symptoms.
Diverticulitis
About half of all adults over 40 may have diverticulosis—a condition in which small pouches form in the lining of the colon. For most people, the pouches aren’t a problem, but in up to 4% of people, some of these diverticula become inflamed or infected. (1) That’s known as diverticulitis and results in symptoms ranging from fever and chills to nausea and left-side abdominal pain. Sometimes diverticulitis can have severe complications, but usually it can be managed without surgery.
So, what leads to Diverticulitis?
People who eat a low-fiber diet appear to be at higher risk, as are those with low vitamin D levels. Maintaining a healthy weight, exercising, minimizing the use of non-steroidal anti-inflammatory drugs, and not smoking seem to lower your chances of diverticulitis. Researchers found that half of diverticulitis cases could be prevented when subjects ate a healthy diet (high fiber, low red meat) exercised two hours per week, maintained a body mass index under 25, and didn’t smoke. (2)
Food Allergies and Sensitivities
Even healthy foods can cause reactions in some people. Anyone can be allergic, sensitive, or intolerant to anything, and “anything can cause anything” when it comes to how people can react to foods. The difference between a food allergy and a food intolerance is whether the body makes antibodies in response to the food. A typical food allergy results in the activation of IgE-mediated antibodies to a protein in the food. Another type of immune reaction to a food is seen in T-cell immune responses, which produce a more delayed reaction, typically over hours or days after eating the food rather than immediately after.
A food intolerance, on the other hand, doesn’t get the immune system involved. Intolerances are much more common with up to 25% of the world’s population having some type of intolerance. A prevalent intolerance is lactose intolerance, which makes it hard for some people to digest milk. This could be due to their lacking the lactase enzyme [link to Glutezyme] or a sensitivity triacylglycerol, the milk fat. (3)
So, what can provide relief from food allergy and sensitivity symptoms?
Someone with a food allergy or intolerance will usually feel better when the food is completely eliminated from his or her diet for about five days. Sometimes you must avoid the foods you’re allergic or sensitive to indefinitely, but in other cases, you may be able to reintroduce them after your time if your gut has healed. Food allergies can be exacerbated by Leaky Gut syndrome and may cause bouts of inflammation, so it's generally a good idea to optimize the health of the intestinal wall.
Gut Infections
Bacterial, fungal, viral, and parasitic infections can mimic other gastrointestinal disorders. Changes in bowel habits or the way your stool looks could be signs that an invisible intruder has taken up residence somewhere in your digestive tract and is interfering with normal functions. Most people have heard of common infectious agents like E. coli, Salmonella, Shigella, Giardia, and enterovirus, but there are many others as well. Often these microbes gain access from improperly handled food or from people who have it and spread it to others by not washing their hands properly. After an initial bout of nausea, vomiting, and/or diarrhea, the body may naturally clear these infections, but in about 10% of cases, symptoms can continue in the form of Irritable Bowel Syndrome (IBS). (4)
The digestive tract has an incomprehensibly large population of bacteria, both beneficial and pathogenic (disease-causing). About 100 billion bacteria live in the large intestine alone. (5) When in normal balance, these bacteria, (your microbiome), aid in digestion and immune function. However, an imbalance of pathogens or even good bacteria can interfere with digestion and produce unwanted symptoms like gas, bloating, and changes in bowel habits.
So, what leads to gut infections?
Using antibiotics can kill off good bacteria and leave harmful bacteria like C. difficile to proliferate, which can lead to diarrhea and inflammation. Good bacteria that belong in the colon can spread into the small intestine and produce a condition called SIBO, small intestinal bacterial overgrowth. Slow transit time [link to Magnesium Citrate] and poor intestinal motility are risk factors for developing SIBO. Symptoms of SIBO include nausea, loss of appetite, bloating, and feeling uncomfortably full after eating. Keeping your microbiota balanced is a cornerstone of good digestive health. Eating yogurt and fermented foods and taking a probiotic supplement can help.
Irritable Bowel Syndrome
The prevalence of Irritable Bowel Syndrome (IBS) outpaces that of Inflammatory Bowel Disease, celiac disease, and diverticulitis combined. Up to 15% of American adults experience this condition; in fact, it is the most common diagnosis patients receive from a gastroenterologist. It is a group of symptoms—a syndrome—rather than a disease, and it’s a functional disorder that doesn’t produce physical damage to the gastrointestinal tract. Even though it isn’t associated with serious medical consequences, the impact on a sufferer’s quality of life is significant. It is second only to the common cold as a reason why employees miss work. It may be responsible for a loss of $30 to $90 billion per year of productivity in the US. (6)
Onset usually occurs during late adolescence to early adulthood and is often triggered by emotional stress. People with IBS often have other chronic conditions like fibromyalgia, chronic fatigue syndrome, or TMJ syndrome. More women than men have IBS. “Nervous stomach” and “spastic colon” are other terms that have been used to describe this condition that causes symptoms such as abdominal pain, alternating constipation and diarrhea, gas, bloating, and nausea. After ruling out other conditions, gastroenterologists may diagnose a patient with IBS if symptoms have lasted at least 12 weeks, started with changes in the frequency and form of the patient’s stools, and lessen with a bowel movement.
Part of successfully managing IBS is learning to recognize what triggers your symptoms, whether foods, stressors, hormones, or environmental exposures. Keeping a symptom log can help. Many people find relief from changing their diet, especially by following a “low FODMAP diet,” which avoids foods that are high in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), which are thought to be harder for people with IBS to digest. (8) Some high FODMAP foods are apples, dried fruit, cow’s milk, ice cream, legumes and wheat, while low FODMAP foods include carrots, cucumbers, lettuce, oranges, strawberries, hard cheeses, eggs, and oats. Nutritional supplements [link to other article] can also help some people with IBS. Probiotics, aloe vera, zinc carnosine, and glutamine can all have a healing and calming effect on the digestive tract.
So, what leads to Irritable Bowel Syndrome?
As with many gastrointestinal disorders, the causes of IBS are not well understood. However, emerging research suggest that the “gut-brain axis” plays a role. Changes in “gut motility,” the contractions that move digesting food through the intestines, depend on a feedback loop between the digestive tract and the brain known as the gut-brain axis.” Alterations in the metabolism of the neurotransmitter serotonin seem to influence the alternating diarrhea and constipation that occurs in IBS. (7)
Ulcerative Colitis
About 900,000 Americans may have ulcerative colitis, which is a condition similar to Crohn’s disease and included in IBD. Although they are often confused due to the similarity of their acronyms, IBD (Inflammatory Bowel Disease) is a separate condition form IBS (Irritable Bowel Syndrome). With IBD, destructive damage occurs to the intestines with possibly permanent harm, whereas IBS is a functional syndrome that doesn’t cause physical harm to the digestive tract. IBD includes Crohn’s disease and ulcerative colitis.
With ulcerative colitis, only the large intestine is affected. Like Crohn’s, it is an auto-immune disorder in which the body attacks the lining of the digestive tract and causes damage—in this case sores or ulcers in the colon. Symptoms include frequent and urgent bowel movements, painful diarrhea, bloody stool, abdominal cramps, weight loss, stomach pain, and frequent abdominal sounds.
So, what leads to Ulcerative Colitis?
Risk factors include having a genetic predisposition and other immune disorders. It is possible that allergic responses, viruses, or bacteria start the process by provoking the auto-immune response.
Digestive problems interfere with more than meals.
They can make you miserable day in and day out. But help is available. Consult your healthcare provider for a diagnosis, then check back with Global Wellness Lab.
We’ll do our best to guide you in the right directions with practical tips on diet, lifestyle, and nutritional aids to help you feel your best—no matter what’s causing your symptoms. GWL also can coach you through comprehensive wellness programs to help you improve and manage chronic gut symptoms and conditions.
If you have a chronic gut condition, add these other guides to your field gear!
References:
1 . Swanson SM, Strate LL. Acute Colonic Diverticulitis [published correction appears in Ann Intern Med. 2020 May 5;172(9):640]. Ann Intern Med. 2018;168(9):ITC65-ITC80. doi:10.7326/AITC201805010
2. Strate LL, Keeley BR, Cao Y, Wu K, Giovannucci EL, Chan AT. Western Dietary Pattern Increases, and Prudent Dietary Pattern Decreases, Risk of Incident Diverticulitis in a Prospective Cohort Study. Gastroenterology. 2017 Apr; 152(5):1023-1030.e2.
3. Crowe SE. Food Allergy Vs Food Intolerance in Patients with Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2019;15(1):38-40.
4. Grover M. Role of gut pathogens in development of irritable bowel syndrome. Indian J Med Res. 2014;139(1):11-18.
5. Sender R, Fuchs S, Milo R. Revised Estimates for the Number of Human and Bacteria Cells in the Body. PLoS Biol. 2016;14(8):e1002533. doi:10.1371/journal.pbio.1002533
6. American College of Gastroenterology [see here].
7. Pei C, Kin C, Yeng L, Fen W, Priya M, Chen Y. The Microbiome and Irritable Bowel Syndrome – A Review on the Pathophysiology, Current Research and Future Therapy. Frontiers in Microbiology 2019(10):1136. DOI=10.3389/fmicb.2019.01136
8. Halmos EP, Gibson PR. Controversies and Reality of the FODMAP Diet for Patients With Irritable Bowel Syndrome. Journal of Gastroenterology and Hepatology. March 2019.