The Fiber Guide

Fiber is probably one of the most misunderstood dietary components. Many people, even physicians, are confused about the different types of fiber, the benefits, and how much fiber should be consumed. This article should help you better understand the role of fiber and its importance to your health.

What is Fiber?

Fiber is a polysaccharide, sugar-like substance that comes in hundreds of forms. Dietary fiber is the indigestible portion of plant foods found mainly in its outer layers. Fiber passes through the human digestive tract virtually unchanged, without being broken down into nutrients. Most people know the importance of fiber, but few really understand how to best integrate fiber into a diet.

How much?

Over a hundred years ago, a change in the way wheat was processed substantially removed the dietary fiber in flour. Because of this, most of us only consume a small fraction of the amount of recommended daily fiber. In fact, the average American consumes only about 10% of the fiber that was part of a normal diet 100 years ago. The human body is well designed to accommodate many of the different types of fiber found naturally in foods. In fact, the National Academy of Sciences Institute of Medicine recommends 30-38 grams of fiber for men and 21-25 grams of fiber for women, each day.

Understanding fiber:

Dietary fibers are mostly soluble or insoluble. Fibers that dissolve in water (soluble) make a gel-like substance that may soften stools, hold cholesterol and fats, and lower blood sugar. Soluble fibers promote increased growth of essential bacteria in the colon thereby increasing bulk. Some examples are fruits, wheat, leafy vegetables, oats, beans and substances such as celluloses, pectin, psyllium and gums. Fibers that do not dissolve in water (insoluble), bind water in the colon. This sponge-like effect bulks stools and binds materials such as bile and potential carcinogens. Examples of insoluble fibers include whole grains, cereals, vegetables corn, rice, and bran. Both soluble and insoluble fibers may help patients with irritable bowel syndrome, diverticular disease, heart disease, and obesity. They may also potentially reduce the risk of colorectal cancer.

How to take fiber:

High fiber foods are good for your health, but adding too much too quickly can promote intestinal gas, bloating and cramps. Increase fiber in your diet gradually over a few weeks including plenty of fluids (6-8 glasses a day). This will allow your digestive system the appropriate time to adjust. The best sources of fiber are those found in foods. Eating a diet rich in fiber will incorporate varieties of fiber, both soluble and insoluble, that’s healthier than fiber supplements as they contain essential vitamins and minerals not found in supplements. However, some people may need supplements for certain medical problems if dietary changes do not supply enough daily fiber.

Food choices:

Many everyday low-fiber foods do have high-fiber alternatives, so make smart food choices. Also, it’s important to know that freezing, drying, and normal cooking do not significantly alter the fiber content of most foods.

The HALO System: Removing the Risk of Barrett’s Esophagus

Barrett’s esophagus is a condition in which the cells that normally line the lower portion of the esophagus are replaced by tissue that is usually found lower in the intestine. This process, called metaplasia, is believed in some part to occur as a result of chronic reflux of stomach acid back into the esophagus (gastroesophageal reflux disease, or GERD).  Overtime, this chronic regurgitation causes damage to the normal esophageal lining. In the body’s attempt to heal and protect, it grows different cells thus leading to Barrett’s esophagus.

Barrett’s esophagus itself usually causes no symptoms. It is diagnosed when a gastroenterologist performs an endoscopy on a patient to further evaluate symptoms such as chronic reflux, heartburn, or even difficulty swallowing. If your healthcare provider identifies tissue that appears abnormal, he or she will take samples to help determine if Barrett’s esophagus is present. The significance of having Barrett’s is that it is associated with a much higher risk of developing esophageal adenocarcinoma. Fortunately, even those who have Barrett’s esophagus have a very low risk (less than 0.5% of patients per year) of developing esophageal cancer.

Unfortunately, at the present time, there is no reliable way to determine which patients with Barrett’s esophagus may go on to develop esophageal cancer. It is fairly typical for a healthcare provider to recommend those who have Barrett’s to undergo surveillance of this condition with endoscopy at regular intervals. This may help to identify tissue that is dysplastic (pre-malignant).

Although commonly recommended to patients with Barrett’s esophagus, the use of antacids has not been shown to prevent the development of cancer. Treatment for people with Barrett’s esophagus and dysplasia is individualized and can vary from surgery or endoscopic resection to using photosensitizers (PDT) and radiofrequency ablation (RFA).

In 2005, the HALO System was approved for use by the FDA for the ablation of Barrett’s esophagus in those select patients who have developed dysplasia. This system uses radiofrequency to destroy Barrett’s tissue that has been previously identified during endoscopy. Even though radiofrequency has been used for many years for the treatment of Barrett’s, there has been no reliable method that was safe, effective and easy for both patients and their physicians until the development of the HALO System.

In an outpatient setting, the HALO System is used during endoscopy to destroy the Barrett’s tissue with minimal risk. It has been studied extensively in both the United States and Europe and has been shown in some studies to be over 98% effective in eliminating dysplastic tissue (pre-malignant cells).

Recent studies estimate that well over 3 million Americans over 50 years of age suffer from Barrett’s esophagus. If you have Barrett’s esophagus, speak to your Gastro Health physician to see if you may be a good candidate for the HALO System.

The Pill Camera

What is it?

Capsule endoscopy refers to a relatively new technology that gastroenterologists use to examine the deepest portions of the digestive tract. In 1981, an Israeli engineer named Dr. Gavriel Iddan began work on designing a disposable pill-sized camera that could be swallowed and would pass directly through the intestine. In 2001, after twenty years of research and development, the FDA approved the Given Diagnostic Imaging System called

Capsule EndoscopyHow does it work?

An “endocapsule” is a miniature video camera that has been incorporated into a capsule-shaped device along with a light source, transmitter and battery. It has a biocompatible coating which allows it to be safely swallowed and pass undigested through the intestinal tract. During this journey, it transmits over 50,000 color images via radio frequency to a recorder worn on a belt on a patient’s hip or waist. The pill weights only 1/7th of an ounce and is about the size of a large vitamin. Once swallowed, the capsule moves through the intestine, naturally aided by the muscular contractions of the intestine.

What does it do?

Since the advent of capsule endoscopy, gastroenterologists have been able to make diagnoses not previously made using conventional methods. For example, in disease such as Celiac Sprue and Crohn’s disease, the endocapsule has assisted in visualizing areas that were previously unreachable without major surgery. Additionally, capsule endoscopy has played a major role in advancing the diagnosis and treatment of obscure gastrointestinal bleeding. Additionally, it has been helpful in identifying tumors of the small intestine and evaluating polyposis syndromes. Subsequent development of an esophageal capsule also provides a modality to monitor GERD (gastroesophageal reflux disease) non-invasively.

What to expect

Typically, patients undergoing an endocapsule study will have a preparation that will consist of a brief fasting period. Some physicians may also recommend a bowel prep to cleanse the small intestine before the study. This outpatient procedure will begin in your doctors office. After a brief orientation, you will swallow the endocapsule and be asked to wear a small data recorder around your waist during the test.  You will be able to drink clear liquids and eat a light meal about two hours after the pill has been swallowed. Approximately 8 hours later, you will be asked to return to your doctor’s office so the data recorder can be removed and the images downloaded to a computer for physician viewing. The capsule will then be eliminated from your body normally in your feces during a bowel movement.

To date, well over a million endocapsules have been used in clinical practice and demonstrated the overall safety of this technology. Complications are extremely rare, especially when performed by specialists who have extensive experience with the endocapsule. Wireless capsule endoscopy is a safe, reliable, and noninvasive technology that can be very useful in the diagnosis and treatment of disorders of the esophagus and small intestine. If you are interested in this exam or think that it may be beneficial to your treatment, ask your physician for more information.

IBS: The Old and The New

IBS (irritable bowel syndrome) is functional disorder of the gastrointestinal tract, meaning it is caused by a problem with the way the gastrointestinal tract works.  People who suffer from IBS do not have intestinal tract damage, but rather suffer from a constellation of symptoms that occur together.

For those people recently diagnosed with IBS or those who have suffered for many years, it remains important to understand that IBS is a chronic but manageable condition. There is no single treatment or medication for IBS. Successful treatment depends on a close and on-going relationship with your physician as well as lifestyle and dietary changes and the use of medications.

Lifestyle and Dietary Changes

Keeping a dietary log will help you recognize foods that may trigger symptoms. Limiting caffeine and alcohol intake, minimizing dairy products, and avoiding sugar substitutes and artificial sweeteners can significantly decrease the frequency and urgency of diarrhea.  Avoiding beans, uncooked vegetables and lowering the fat content of your foods may alleviate gassiness and bloating. Daily fiber supplements and increased water intake help with constipation-predominant IBD (IBS-C).

In addition to dietary changes, lifestyle modifications help reduce symptoms in IBS as well.  Smoking cessation is critical for overall health as well as the health of your intestinal tract. Regular physical exercise has been shown to reduce the frequency of symptoms and protect against symptom deterioration. Several studies have also demonstrated the benefits of stress management through behavioral modification on the symptoms of IBS.

Medications for IBS

Keeping in mind that the treatment of IBS is multi-faceted, medications play an important role.  Traditionally anticholinergic medications such as Bentyl and Nulev have been used to help temporarily alleviate bloating and discomfort.  Imodium can be helpful for those with frequent diarrhea and urgency. Fiber supplements seem to benefit those with constipation and alternating IBS-D and IBS-C. Antidepressants and anti-anxiety medication may also provide some benefit for more chronic symptoms.  Within the last several years, probiotics and even antibiotics have been used with some success in IBS. This benefit may be due, in part, to bacterial imbalances in the intestine that may exist in patients who suffer from IBS.

Some of the recently approved medications for IBS have a more specific focus. Several years ago, Lotronex (Alosetron) was approved for women with IBS and diarrhea; this medication is designed to relax the intestine and slow the transit of stool thereby helping with diarrhea and bloating.  Only a gastroenterologist should prescribe this medication. Amitiza (Lubiprostone) is prescribed for adult women and men who have IBS with constipation. It is taken twice a day and works by increasing the fluid secretion into your intestine thereby softening your stool and increasing bowel movements. This medication has a long track record and has been shown to be safe and effective in patients with IBS-C and also those with chronic constipation as well. The “new kid on the block” is Linzess (Linaclotide). It is a novel medication that gained FDA approval in late 2012 to treat patients with chronic constipation and those with IBS and constipation. Linzess is taken once daily and has been shown to relieve discomfort associated with IBS-C and help with more complete evacuation of stools.

IBS Symptoms Can Be Treated

Estimates suggest that IBS affects up to 15% of Americans. Because of its chronic and episodic nature, IBS has considerable impact on its sufferers’ lives. The most important thing to keep in mind is that IBS symptoms can be treated. Establish a good relationship with your physician and make sure you are fully evaluated for other potential underlying diseases. Treatment of IBS involves long-term strategies using a combination of lifestyle changes, dietary modifications and medication to minimize symptoms.

Inside the Bacteria: Helicobacter Pylori

Helicobacter Pylori (H. Pylori) is a bacteria found in the stomach. It was initially identified in 1982 when scientists discovered that this particular bacteria was present in patients suffering from chronic gastritis and gastric ulcers. Infection with H. Pylori can contribute to the development of gastritis (inflammation of the stomach), gastric or duodenal ulcers, and dyspepsia (upset stomach and or indigestion). Prior to the discovery of H. Pylori, it was presumed that these conditions were more likely due to medications such as anti-inflammatories and steroids, alcohol and even stress. Since then, H. Pylori has also been identified as a risk factor for the development of gastric cancer.

H. Pylori is likely one of the most common bacterial infections worldwide. In fact, it has been estimated that close to 50% of the world’s population may have H. Pylori. Individuals who have H. Pylori likely acquire the infection when the bacteria is swallowed. It may be present in food, fluids or even utensils and is usually passed on from one person to another. And while often acquired as a youth, H. Pylori infection rates do increase with aging. Infection with H. Pylori is more frequently found in people from developing countries and those living in large cities with diverse populations. Additionally, infection rates tend to be higher in areas of poor sanitation and crowded living spaces. It is important to keep in mind that while H. Pylori can cause several conditions, many if not most (approximately 80%) of those infected will remain asymptomatic.

How is H. Pylori infection diagnosed?

Presently, there are several ways to detect the presence of H. Pylori in an individual. There are specific stool tests, serology (blood tests), and a breathing test, all of which can be done in a doctor’s office. Perhaps the most accurate and definitive way to diagnose this bacteria is during endoscopy. This is a procedure performed by a gastroenterologist during which a flexible camera is introduced into the stomach through the mouth and tissue samples of the stomach are removed for analysis. This painless procedure can be done as an outpatient very safely and rapidly.

H. Pylori has been implicated in chronic gastritis and dyspepsia. Patients suffering from these conditions may have nausea, bloating and abdominal discomfort characterized by burning and upper abdominal pain. H. Pylori is also often the cause of both gastric and duodenal ulcers. When H. Pylori is found in the setting of ulcers, it should be treated. This will help both heal the ulcers and prevent their recurrence. Stomach cancer and certain types of gastric lymphomas may also be related to infection with H. Pylori. It is important to understand that while H. Pylori infection is very common, very few of those who have it will ever develop these types of cancers.

Since infection with H. Pylori is so common, and so few people are affected or have symptoms, it is not recommended to test for this bacteria unless your doctor determines that it may be necessary. There are several treatment regimens that exist, but all require multiple medications. Often, two antibiotics are used along with antacid medications. The specific medications and duration of treatment should be determined on an individual basis by your physician. Testing to ensure eradication of H. Pylori is not always necessary but may be important and should be discussed with your doctor.

While the incidence of H. Pylori in Western countries is on decline, detecting and treating H. Pylori may be an important part of your well-being and overall health. Your physician can help assist you in determining if testing for H. Pylori is important to your healthcare.