Column Dr. Pomeranian: diet and bowel health

There is ample information on nutritional issues in all media. It is not easy for the doctor to find out what is useful or even harmful. There is no lack of half-truths and untruths. In a healthy diet, all micro and macronutrients are actually present. Therefore, in nutritional medicine, based on studies, there is no doubt that the prophylactic use of dietary supplements in healthy people does not offer any benefit. The situation is different when people have chronic inflammatory bowel disease or liver disease.

People with celiac disease also need iron, vitamin D, B12, K, folic acid and micronutrients, for example, which can be prescribed by a doctor. A particularly difficult problem is the distinction between food intolerances and food allergies. These occur in around 2-8% in Germany. They can be clearly demonstrated by special examinations, as they are immune-mediated. The test is made possible with a step-by-step diagnosis. About 25-30 percent of the population suffers from intolerances. In these cases, careful documentation (food diary) of the patient’s food intake is often very useful. A special “widespread disease” is the so-called irritable bowel syndrome, which affects about 11% of people worldwide.

Some patients with irritable bowel syndrome (IBS) suffer from constipation problems, while others struggle more with diarrhea-like symptoms. In recent years, the connection with bacterial colonization of the intestine (microbiome), but also of the gut-brain axis, has been the subject of scientific discussion. The treatment is carried out in addition to the nutritional therapy with a treatment in the sense of a microbiome therapy, possibly a drug therapy. In some cases, psychotherapy is needed. Research is intensely concerned with the question of whether the microbiome plays a significant role in the development and progression of inflammatory bowel diseases (ulcerative colitis, Crohn’s disease). This is a completely new therapeutic approach: up to now attempts have been made to treat intestinal inflammation with anti-inflammatory and so-called immunosuppressive preparations.

The importance of a high-fiber diet has been confirmed once again. The guideline is 30 grams per day. This value is not reached in most cases (18 to 19 grams / day). A sufficient liquid supply of approximately 1.5 liters is required for this. With this diet, effects on the development of cardiovascular diseases are detectable, but also an influence on hypertension, type 2 diabetes and the development of intestinal cancer. The diet should contain vegetables, fruits, legumes, nuts and whole grains.

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