The Un-Constipated Gourmet: Secrets to a Moveable Feast

Stacey Palevsky, on JWeekly.com (J as in Jewish):

was thrilled when the book "The Un-Constipated Gourmet: Secrets to a Moveable Feast" arrived in our newsroom last month.

My editor was appalled by the title. I was unfazed. And excited. Finally, a cookbook for people with troubled intestines.

I'd be thrilled, too. What a great concept.

The book's author is Danielle Svetkov, a Jewish native of Larkspur now living in San Francisco. She writes out of a Jewish tradition, for Jews...

Studies indicate both Jewish men and women suffer digestive maladies in disproportionate numbers.

Jews are two to four times more likely than non-Jews to have a spectrum of digestive ailments, such as Crohn’s disease, Irritable Bowel Syndrome, food allergies or lactose intolerance.

...and not for Jews:

But her recipes are not exclusively for the Jewish dinner table, because “there’s a broad audience for this cookbook,” she said. Pregnant women, couch potatoes, travelers and seniors also are often plagued with digestive ailments.

The recipes seem to be high-fiber dishes, using a variety of fibrous ingredients to give it taste.

Product Description

Now, millions of Americans can beat constipation, without giving up gourmet food.

Millions of Americans have to pass up good food because of their bad problem - constipation. In 2004 alone, there were 41.3 million visits to physicians for digestive system symptoms.

[The Un-Constipated Gourmet: Secrets to a Moveable Feast – 125 Recipes for the Regularity Challenged] is the kind of cookbook home chefs can count on every day to deliver regular meals with exotic variety and homey comforts. For the family cook, it has the main courses, sides, and deserts that will keep everyone moving: pasta puttanesca on Monday, pizza with shrimp on Tuesday, and pork chops on Thursday. [The Un-Constipated Gourmet: Secrets to a Moveable Feast – 125 Recipes for the Regularity Challenged] is the go-to cookbook for anyone who wants the pleasure of a great meal without worrying about the side effects.

(Puttanesca, pizza with shrimp, and pork chops? Can Jews eat any of the recipes?)

Constipation isn't normally an issue that those with lactose intolerance ever have to deal with, but other with dairy issues definitely do. And fiber is yet another of those things Americans don't get enough of in their diets.

How Long Does a Lactose Attack Last?

I hate getting questions that I can't answer, but "it depends" is all-too-often the only real comment that I can make.

This was in an email I recently received:

After reading pretty much everything on your website and a lot of others, I still haven't found the answer to this question: How long after you stop consuming lactose does it clear your system and stop causing symptoms? Are there any residual effects and/or damage to the gut?

There is very little that's more individual than a lactose attack. It varies not just by person to person, but every single time you take in more lactose than you can digest. How much lactose you eat, whether it's part of a meal or whether it's mostly liquid, how much lactase may remain in your system, and how sensitive your intestines are all play a major role.

The symptoms may be mild or severe and may last for a short time or for quite a while.

You cannot damage the gut by having lactose. If you are particularly sensitive or also have Irritable Bowel Syndrome, your intestines may keep on spasming even after the lactose is gone. At that point taking an antidiarrheal drug to stop the spasming is a good idea. Don't take one right away thinking that you're stopping the symptoms. You'd just be keeping the lactose in you longer.

Extreme cases of lactose intolerance (LI), meaning times when someone keeps having milk despite the symptoms, can lead to dehydration from the water loss. That used to happen in the days before people knew what LI was. (If you didn't know that milk caused your problem you wouldn't think to stop having it.) I haven't heard of a case of dehydration in a very long time. Knowing all about LI is far too common in the U.S. This might be a concern in some other countries where understanding of LI is just beginning to reach our levels.

LI is uncomfortable but not dangerous. The sympotms will go away when the lactose is gone (and you make sure not take in more lactose). It just seems like forever.

Solving the Mystery of IBS

Irritable Bowel Syndrome (IBS) is a mystery disease. Or not a disease. A syndrome, after all, is technically a collection of symptoms grouped together by hope and desperation more than logic. Maybe one thing causes them. Maybe not.

With IBS, the causes are many and deeply disputed. At least doctors (good ones, at any rate) have stopped telling patients it's all about stress. Researchers are pretty sure than someone real is going wrong deep inside the digestive tract.

There is also a disease called Inflammatory Bowel Disease (IBD) which, despite the name and the similarity of symptoms, was thought not to be the same thing as IBS. That might be wrong as well.

The British science magazine The New Scientist had a small article on a research study on IBS, "Getting to the bottom of irritable bowels, by Ken Boroom in their 13 April 2008 issue.

In the article, Boroom talks about an article, "Role for protease activity in visceral pain in irritable bowel syndrome", by Nicolas Cenac. It's from the Journal of Clinical Investigation 117(3): 636-647 (2007). doi:10.1172/JCI29255.

That issue was published on Feb. 15, 2007. The New Scientist is a weekly magazine that normally gives the latest breaking news. Why did they wait over a year to report this? Probably it took Boroom a year to figure out what the heck the report says. It would me.

To take his word for it, there is some really important news buried in the jargon.

You see, people with IBS can have seemingly contradictory symptoms. Some have diarrhea; some have constipation. So far researchers hadn't come up with a common link for both sets of symptoms. Cenac's group has.

They found increased activity of a group of enzymes called serine proteases in all the IBS patients and at double the levels of healthy patients. Not just that, IBD patients also had raised protease activity.

Activity in this case means that a receptor called PAR2, found on nerve cells, epithelial cells, and smooth muscle cells, is activated. Boroom wrote:

If these cells are being overstimulated in IBS patients, it may explain why they complain of widespread pain and hypersensitivity as well as abdominal symptoms.

The natural next step is to look for a protease inhibitor. And in fact one is in trials in Japan as a treatment for IBS, with what Boroom called "promising results."

Many people with IBS also have lactose intolerance (LI). I'm one of them. It's never been clear exactly what the relationship between LI and IBS might be exactly, but it's a major problem for the LI community. A way to stamp out IBS would go a long way toward treating what is probably an underlying condition in the unusual level of suffering that people with LI get that really can't be explained by LI reactions alone.

Good news, even if tangible results are probably still years away.

Answers to Questions from Readers, part 5

Q. Doesn't there have to be some type of LI measurement degree scale so that I know just how intolerant I am?

You would think so, wouldn't you?

But, as far as I can tell, you would be wrong. This bothers me too, but in all my research I have never come across any discussion of a scale of degrees of LI. In all the medical journal articles I have read, a simple threshold is used. Anybody who goes over that threshold is considered to be LI. The amount over the threshold is never considered. In fact, I have seen it stated that there is no correlation, although I do not know what the justification for this statement is.

In reality, symptoms are based on so many other factors than just the amount of lactase one produces that it would indeed be very difficult to make more definitive statements, but I would like to see some research done to clarify this point. You might also want to take a look at my Lactase page in the LI Basics section of my web site for more on why symptoms may vary so greatly.

Q. I think that I might be lactose intolerant. What type of doctor should I see to confirm if I am or not?

That really depends on your situation. Most family doctors can send you to a clinic for a test. However, some will prefer to send you to a specialist gastroenterologist. That's because many of the symptoms of LI are also symptoms of some much more serious problems and they want to eliminate them as possibilities first. Then you'll get sent to a clinic for a test. (Or to a hospital or whoever does it in your area.)
So you probably should just start at your regular doctor. However, if you just want to see one doctor and don't need to get a referral for insurance or HMO reasons, see a gastroenterologist.

Q. I have two vegan friends who eat no milk products, and they both have VERY strong feelings that the American Dairy Association is spitting out propaganda by telling us that we need to drink so much milk. I have been brought up drinking skim milk at every meal, and feeling healthy and happy about it - so my gut reaction is that milk IS good for you. What do you think?

The odd answer is that you are both right.

Yes, the milk industry has always been a propagandist for milk. Why should this surprise anyone? That's its job.

And vegans can live perfectly healthy lives without ever touching a milk product. That's their job.

So?

So, everybody is missing the real issue. Is milk good for you, personally? Of course it is. It has large amounts of lots of nutrients, and in a form that most people find preferable to the alternatives. Whole milk does have a large amount of fat, true, but since you drink skim milk, that's not a problem. There are people who believe that milk does awful things to you, but I see no widespread evidence of any of these ills in the general public.

My bottom line has always been that if you want to drink milk -- or use milk products -- you should go ahead and do so. As long as you do so moderately and in the proverbial balanced diet, you'll be just fine. And if you don't ever want to use milk, then there is absolutely no need to. You can get every nutrient from other sources, and as long as you do so moderately and in the proverbial balanced diet, you'll be just fine.

There. Feel better now?

Q. Have you heard of anyone's LI symptoms being relieved by birth control pills?

The problem is that I hear all sorts of anecdotal comments about LI, without ever being able to back them up. I have heard of women becoming LI because of pregnancy and also of women being able to drink milk for the first time while pregnant. I do not, however, know of any studies that would shed any light on the subject. But you are definitely the first to give a connection to bcp's. (However, as all but one brand of bcp's contain lactose as a filler, it's probably not surprising that few people see their symptoms disappear while on them.)

Q. Our doctor thinks my daughter has irritable bowel syndrome, but with lactose intolerance as a trigger. I'm wondering if I am giving her enough Lactaid. Do you have any thoughts on this?

While it couldn't hurt, it's not clear that it would do much to help unless you think you are still not detecting all milk products at those meals.

You might want to go in a different direction. There are numerous other triggers of irritable bowel other than milk. They include: large meals, fatty or spicy foods, carbonated beverages, and caffeine. Gas-producing foods, like beans and cabbage, can also be a problem. So can sorbital, the artificial sweetener. Even some fiber sources, including lettuce, celery, and fruits, may cause gas and bloating. If you detect a pattern of symptoms in conjunction with any of these, try removing it from her diet for a few days and see if that helps.

Q. How does heat affect lactose? Does baking alter lactose? If I see non-fat milk in a bread label, has the lactose been altered to the point that it no longer poses a problem for me?

Unfortunately, there is no evidence that heat affects lactose in any way. Lactose in pure form, in mostly pure form (whey) and as a small percentage of other milk products, is used in hundreds of foods and people seem to respond to all of them. Of course, most people do _not_ respond to small amounts of lactose, so size does matter, as they say. But you do need to take lactose into account in any food that it is in.

To know how much lactose is in various milk products, see the SuperGuide to Dairy or the Lactose Percentages pages in the Dairy Facts section of my web site.

IBS - Irritated Being Single

There's no question that having digestive problems is a handicap to romance. Even the most loving spouse has to put up with a plenitude of embarrassing and exasperating situations. Now imagine trying to find a dating partner given that handicap.

Craig Jex has a solution to offer. Irritated Being Single is the first online dating service for those with digestive problems.

The site says:

The dating scene can be difficult for anyone. But if you suffer from Irritable Bowel Syndrome (IBS) or Crohn's Disease it can be cause of added anxiety and embarrassment. Irritated Being Single is here to aid IBS and Crohn's Disease sufferers who would like to date but find it difficult to build new relationships due to symptoms that can be beyond their control. There is no better feeling than being with someone who understands exactly what you are going through.

That is why Irritated Being Single hope IBS and Crohn's Disease sufferers as well as sufferers of any other bowel disorder will embrace this dating service in the wish of meeting their soul mate without being embarrassed about their conditions.

Craig was interviewed on Tim Phelan's blog. Here's an excerpt:

The site went live in April 2006 and is slowly growing with members. When I discussed the idea of having a dating site for sufferers of IBS the reaction was quite mixed. There were a few people who thought it was a bad idea. Their thoughts being that people don’t like to talk about poo and who would want to go out with someone who constantly needed to use the toilet. Some of their points I could understand but others were a little narrow minded. But I’m used to that; I can’t tell you the number of times people have said that my IBS is all in my head – I think that’s the worst thing you could say to someone who suffers from this condition. Everyone has suffered from the shits at one stage or another in their lifetime so if they can just imagine what that must be like to live with every day then they would soon realise it’s not all in our heads.

Dating is always a nerve wracking experience and having IBS makes it that little bit worse so having a dating site where sufferers wouldn’t have to worry about their condition had people thinking it was a good idea.

Although, the majority of people probably thought it was a good idea especially when you take into account the figures you mentioned due to the fact that if half of the world’s IBS sufferers signed up I would be a millionaire. Those figures really are amazing especially when you consider those who haven’t been diagnosed yet as they’re too afraid to bring their bowel habits up with a doctor.

The signups are growing very slowly. On This is Local London (yes, Craig's site is a UK site) Kerry McQueeney wrote:

He has 70 people registered on the website but hopes more will come forward when they hear of it.

They should. Channel 4 is due to screen a documentary about Craig and the website at the end of August.

$3800 Mistake

When you're peddling a research report for the astounding price of $3800 you'd think you'd take the time to be sure your pitch has been proofread.

Not the Datamonitor people. Or perhaps the blame goes to the shoddy coders at Pharmaceutical Business Review Online.

Whichever. One of them is responsible for this:

Irritable bowel syndrome (IBS) is a common disease affecting 1020% of the total adult population...

Despite the substantial impact IBS can have on sufferers' well being, about 7080% of sufferers have not been formerly diagnosed.

Wow! No wonder those of us with IBS feel so lousy. We each have it ten times over.

And this in a report whose justification of its price is so that you can:

Quantify the key target segments of the IBS patient population across the seven major markets

Quantify your press releases first, please.