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How Diet Can Change the Course of GI Disease

According to Eamonn Quigley, MD, diet can, in fact, change the natural course of history for gastrointestinal disease. In an article published in the international Journal of Gastroenterology and Hepatology, he reported that diet plays a critical role in gut function in several GI diseases along with the many manifestations of food allergies, eosinophilic esophagitis and celiac disease. In these disorders, dietary management can impact the natural history of GI disease. In other disorders, diet is a cofactor, and its relative importance continues to be deﬁned, which is also noted.

Eamonn Quigley, MD

“The first thing we need to do is to take food seriously,” said Quigley, David M. Underwood Chair of Medicine in Digestive Disorders and Director, Underwood Center for Digestive Health. “The second thing is that we need to focus on the science. Not trends and conspiracies.” The real risk he has discovered is that some people are too concerned about their diet that they end up not eating enough food. “There is a danger, when you don’t eat enough resulting in developing an eating disorder. Eating disorders are life-threatening,” he noted. “Otherwise, mortality rates for GI diseases are very low, so ‘disability’ becomes the issue, and quality of life is affected.”

Quigley said conducting the review he presented was a “tall order,” but something he has kept an eye on for years. He analyzed personal observations as well as volumes of literature in research.

“Every single day that I have clinic, I encounter patients who say, ‘Doctor, I have a food allergy.’ However, food allergies are relatively rare, but food intolerance is quite common,” he said. “It’s basically, a situation where you can’t handle certain foods because you don’t have enough of the proper digestive enzyme.” Now, studies are beginning to show higher than expected rates of “convincing food allergy” at approximately eight percent for children and11 percent for adults in the United States. Higher rates across adulthood are contrary to the traditional view of food allergy as a childhood disorder.

The first thing we need to do is to take food seriously. The second thing is that we need to focus on the science. Not trends and conspiracies.

Eamonn Quigley, MD

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Celiac disease, a disorder that is growing in prevalence, is an example of where diet can completely change the natural history of the disease, he said. Sufferers get better, the damage heals, and “everything is fine.” “There is no doubt that a gluten-free diet, if strictly adhered to, will alter the natural history of celiac disease,” he said. But he warns that some patients can confuse celiac disease with a wheat allergy. While individuals with celiac disease may not suffer any related decrease in life expectancy, they may be at greater risk for the development of chronic fatigue, osteoporosis, dermatitis herpetiformis, as well as autoimmune thyroid disease. On long-term follow-up, 20 percent of those with positive serology for celiac disease will ultimately be diagnosed with celiac disease. Taken together, these ﬁndings support screening for celiac disease in at-risk populations, Quigley concluded.

Diet can have a similar long-term impact on at least some patients affected by eosinophilic esophagitis, diarrhea and constipation. Other research evaluated by Quigley found:

People with a true food allergy have worse symptoms during pollen and allergy season.
While lactase deficiency is inherited, in some cases patients have the lactase enzyme, but just not enough of it.
Learning how microbes interact with food is a growing topic.
FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are another area of growing interest.
“While the long-term impact of the low-FODMAP diet continues to be evaluated for IBS sufferers, there is no doubt that the avoidance of food to which one is intolerant can be life-altering,” Quigley said.
Alpha-Gal syndrome is a condition that can be hard to diagnose because it is a delayed response. It is seen in areas like Southeast Texas and Louisiana where the Lone Star tick is endemic. A tick bite leads to the formation of anti-bodies and reacts three to eight hours after various meats and animal products are ingested. Symptoms can range from urticaria to full-blown anaphylaxis.
Exercise-induced anaphylaxis is another area in need of further study. Food is ingested before exercise and the allergic manifestations (urticaria, wheezing, angioedema, GI symptoms such as diarrhea and hypotension) develop in the next 30 minutes after exercise. Though many foods have been reported to be involved in this syndrome, wheat has been the most invoked cofactor.

“The topic of the natural history of GI diseases—what happens in a disease if nothing is done about it—is an important clinical problem with a lot of interest from practicing gastroenterologists who want to help their patients” Quigley said. “We need more research on how diet influences GI diseases. I continue to marvel at new discoveries in this field.” Quigley presented the study as the keynote address at an international conference hosted by the prestigious Monash University in Melbourne, Australia— world famous for its studies and current issues related to digestive diseases and diet.