Ads by Smowtion Media


Iron-deficiency anaemia is a common and easily treated condition that occurs when there is not enough iron in the body. It is the most common type of anaemia. A lack of iron in the body can come from bleeding, not eating enough foods that contain iron, or not absorbing enough iron from food that is eaten.


The term "anaemia" is used for a group of conditions in which the number of red blood cells in the blood is lower than normal, or the red blood cells don't have enough haemoglobin. Haemoglobin�an iron-rich protein that gives the red colour to blood�carries the oxygen from the lungs to the rest of the body. In people with anaemia, the blood does not carry enough oxygen to the rest of the body. Red blood cells also remove carbon dioxide, a waste product, from cells and carry it to the lungs to be exhaled.

Red blood cells also are called RBCs or erythrocytes. Normal red blood cells are all about the same size and look like doughnuts without a hole in the center. They are produced by the spongy marrow inside the large bones of the body. Healthy red blood cells have an average lifespan of 120 days. When they die, the iron from the haemoglobin is recycled to make new red blood cells.

There are many types of anaemia. The three major causes of anaemia are blood loss, decreased production of red blood cells, or increased destruction of red blood cells. White blood cells and platelets are the two other kinds of blood cells. White blood cells help fight infection. Platelets help blood to clot. In some kinds of anaemia, there are low amounts of all three types of blood cells. The most common symptom of all types of anaemia is feeling tired because the body is not receiving enough oxygen.

Iron-Deficiency Anaemia

In iron-deficiency anaemia, the body does not have enough iron to form haemoglobin, which means there is not enough haemoglobin to carry oxygen to the whole body. The body gets its iron from food. The main foods that contain iron are meat and shellfish as well as iron-fortified foods (that is, foods that have iron added). A steady supply of iron is needed to form haemoglobin and healthy red blood cells.

A person can have low iron levels for three reasons:

  • Blood loss, either from disease or injury
  • Not getting enough iron in the diet
  • Not being able to absorb the iron in the diet

Iron-deficiency anaemia also can develop when the body needs higher levels of iron, such as during pregnancy.

Effects of Iron-Deficiency Anaemia on the Body

Iron-deficiency anaemia can range from mild to severe. A mild case usually causes no symptoms or problems. However, a severe case can cause extreme fatigue (tiredness) and weakness. Severe iron-deficiency anaemia can lead to serious problems for young children and pregnant women, and it can affect the heart.

In young children, iron-deficiency anaemia can cause a heart murmur and delays in growth and development. It puts a child at greater risk for lead poisoning and infections, and it can cause behaviour problems.

In pregnant women, iron-deficiency anaemia can increase the risk of a premature delivery and a low-birth-weight baby.

The heart is affected when there is a lack of oxygen in the body. The heart has to work harder to get enough oxygen throughout the body. Over time, this stress on the heart can lead to a fast or irregular heartbeat, chest pain, an enlarged heart, and even heart failure.

Important General Information

A lack of iron in the body is the most common nutritional problem. Iron-deficiency anaemia is the most common form of anaemia. It is most often found in young children, pregnant women, and women of childbearing age. In fact, it affects half of all pregnant women and 1 out of 5 women of childbearing age.


Iron-deficiency anaemia can be treated successfully. The causes of iron-deficiency anaemia can most often be treated successfully as well. However, if not treated, it can lead to severe symptoms and serious problems.

What Causes Iron-Deficiency Anaemia?

Iron-deficiency anaemia occurs when there is too little iron in the body. A person can have a low iron level for three reasons:

  • Blood loss, either from disease or injury
  • Not getting enough iron in the diet
  • Not being able to absorb the iron in the diet

Iron-deficiency anaemia also can develop when the body needs higher levels of iron, such as during pregnancy.

Loss of Iron Through Blood Loss

In general, when blood is lost, iron is lost. If the body does not have enough iron reserves to make up for the iron loss, a person will develop iron-deficiency anaemia.

Blood is lost in a number of ways. In women, iron and red blood cells are lost when bleeding occurs from very long or heavy menstrual periods as well as from childbirth. Women also can lose iron and red blood cells from slowly bleeding fibroids in the uterus.

Blood also is lost through internal bleeding. Most often this loss of blood occurs slowly and can be due to:

  • A bleeding ulcer, colon polyp, or colon cancer
  • Regular use of aspirin or other pain medicine such as nonsteroidal anti-inflammatory drugs (for example, ibuprofen and naproxen)
  • Hookworm infection
  • Urinary tract bleeding

A more rapid loss or removal of blood that can cause iron-deficiency anaemia occurs in situations such as:

  • Severe injuries
  • Surgery
  • Frequent blood drawing

Lack of Iron in the Diet

Meat, poultry, fish, eggs, dairy products, or iron-fortified foods (that is, foods that have iron added) are the best sources of iron found in food. Eating patterns that exclude these foods or food supplements may lead to iron-deficiency anaemia. For example, some vegetarians do not eat enough foods with iron. Other people get iron-deficiency anaemia because of eating poorly due to alcoholism or aging. Following a diet that has an imbalance of food groups also can lead to this type of anaemia. Examples of diets that can lead to iron-deficiency anaemia include:

  • Low-fat diets. Following a low-fat diet over a long period of time may limit sources of iron from animal foods.
  • Diets high in sugars. These types of diets are often low in iron.
  • High-fiber diets. These types of diets can slow the absorption of iron.

Infants who are fed cow's milk in the first year are at risk for iron-deficiency anaemia because cow's milk is low in iron. The same is true for infants who are breastfed after 4 months of age. These infants need iron supplements.

An Increased Need for Iron

People may need more iron at some periods in their lives. If they do not get more iron at these times, they may develop iron-deficiency anaemia. Periods of rapid growth or growth spurts in children and teens are a good example of an increased need for iron. Pregnancy also is an example. The need for iron doubles during pregnancy due to an increased blood volume, the growth of the foetus, and the blood loss that occurs during childbirth.

Inability To Absorb Enough Iron From Food

Certain factors make it hard for the body to absorb enough iron from food. These factors include:

  • Intestinal surgery or diseases of the intestine, such as Crohn's disease or coeliac disease
  • Prescription medicines that reduce acid in the stomach
  • Low levels of folate, vitamin B12, or vitamin C in the diet

How Iron-Deficiency Anaemia Develops

First, iron is lost from the body by one of the ways listed above. Usually, this happens slowly over a period of time. Most often, the person is not taking in enough iron to meet the needs of the body.

Next, the body starts to use iron that it has stored. When the stored iron is used up, new red blood cells have less haemoglobin than normal, and fewer red blood cells are produced. Finally, when the number of red cells is too low, iron-deficiency anaemia develops.

Who Is At Risk for Iron-Deficiency Anaemia?

The major risk factors for iron-deficiency anaemia are blood loss and a diet low in iron. Three of the highest risk groups are women, young children, and adults with intestinal bleeding.

Populations Affected


Women who lose a lot of blood during their monthly periods are at higher risk of developing iron-deficiency anaemia. About 1 in 5 women of childbearing age has iron-deficiency anaemia.

Pregnant women need twice as much iron in their diet than women who are not pregnant. If a pregnant woman doesn't get enough iron for herself and the growing baby, she can develop iron-deficiency anaemia. About half of all pregnant women have this type of anaemia.

Young Children

Infants and toddlers 6�24 months of age need a lot of iron to grow and develop. The iron that full-term infants have stored in their bodies is used up in the first 4�6 months of life. After that, infants need to get iron from food or supplements. Premature and low-birth-weight babies are at even greater risk for iron-deficiency anaemia because they don't have as much iron stored in their bodies.

Other children at risk for anaemia are:

  • Children with poor nutrition, including low-income children
  • Children with lead in their blood
  • Infants fed cow's milk before 1 year of age
  • Breastfed infants older than 4 months who are not receiving iron-rich solid foods or iron supplements

Adults With Intestinal Bleeding

Adults who bleed in their intestinal tract are at risk for iron-deficiency anaemia. This includes people who have bleeding ulcers or colon cancer. It also includes people who use medicines that can cause intestinal bleeding (for example, aspirin).

Other Adults

Other adults who are at risk for iron-deficiency anaemia include those who are on kidney dialysis, vegetarians, and older adults who have poor diets.

What Are the Signs and Symptoms of Iron-Deficiency Anaemia?

Signs and symptoms of anaemia depend on the severity of the condition. People with mild anaemia or anaemia that has come on very slowly may have no symptoms at all. However, if the anaemia is severe, the symptoms increase and become more serious. Many of the signs and symptoms of iron-deficiency anaemia are true for all kinds of anaemia.

Major Signs and Symptoms of Anaemia

The major symptom of all types of anaemia, including iron-deficiency anaemia, is fatigue (feeling tired). Fatigue is caused by having too few red blood cells to carry oxygen to the body. This lack of oxygen in the body can cause people to feel weak or dizzy, have a headache, or even pass out when changing position (for example, standing up).

Since the heart must work harder to move the reduced amount of oxygen, signs and symptoms may include shortness of breath and chest pain. This can lead to a fast or irregular heartbeat or a heart murmur.

In anaemia, the red blood cells don't have enough haemoglobin. Common signs of lack of haemoglobin include pale skin, tongue, gums, and nail beds.

Other Signs and Symptoms of Anaemia

Other signs and symptoms of anaemia can include:

  • Cold hands and feet as well as brittle nails
  • Swelling or soreness of the tongue and cracks in the sides of the mouth
  • An enlarged spleen
  • Frequent infections

Signs and Symptoms of Iron-Deficiency Anaemia

Symptoms of iron-deficiency anaemia include unusual cravings for nonfood items such as ice, dirt, paint, or starch. This craving for nonfood items is called pica.

Another symptom of iron-deficiency anaemia is developing restless legs syndrome (RLS). RLS is a disorder that causes an uncomfortable feeling in the legs that can only be relieved by movement. Sleep is difficult for people with RLS.

In infants and young children, signs and symptoms include a poor appetite, being irritable, and a slower rate of growth and development.

Some of the signs and symptoms of iron-deficiency anaemia are related to its causes, such as blood loss. Blood loss is most often seen with very heavy or long lasting menstrual bleeding or vaginal bleeding in women after menopause. Other signs of internal bleeding are bright red blood in the stool or black, tarry-looking stools.

How Is Iron-Deficiency Anaemia Diagnosed?

Iron-deficiency anaemia is diagnosed using a person's medical history, a physical exam, and diagnostic tests and procedures. A doctor can use these methods to determine how severe the anaemia is, its cause, and appropriate treatment. Mild to moderate anaemia may have no signs or symptoms. In fact, anaemia is often discovered unexpectedly on screening tests and when doctors are checking for other problems.

Specialists Involved

Primary care doctors often diagnose and treat iron-deficiency anaemia. These doctors include paediatricians, family doctors, obstetricians, or internal medicine specialists. Other doctors may be consulted, such as experts on diseases of the blood (haematologists) or experts on diseases of the digestive system (gastroenterologists).

Medical and Family History

To find the cause of the anaemia and how severe it is, the doctor may ask detailed questions about symptoms. The doctor may ask whether the person or a family member has ever had problems with anaemia. The doctor will ask about things that may cause anaemia, including illnesses, conditions (such as pregnancy), and medicines. The doctor also may ask about the person's diet and eating habits.

Physical Exam

A physical exam may include:

  • Checking for pale or yellowish skin, gums, or nail beds
  • Listening to the heart for a rapid or irregular heartbeat
  • Listening to the lungs for rapid or uneven breathing
  • Feeling the abdomen to check the size of the liver and spleen
  • Checking for signs of bleeding, including a pelvic and rectal exam (these areas are common sources of blood loss)

The doctor also will order a number of tests or procedures to be sure about the type of anaemia and how severe it is.

Diagnostic Tests and Procedures

Your doctor may order various tests or procedures to determine the type and severity of anaemia you have. Usually, the first test used to diagnose anaemia is a complete blood count (CBC). The CBC tells a number of things about a person's blood, including:

  • The haemoglobin level. Haemoglobin is the iron-rich protein in red blood cells that carries oxygen through the body. The normal range of haemoglobin levels for the general population is 11.1�15.0 g/dL. A low haemoglobin level means a person has anaemia.
  • The haematocrit (hee-MAT-oh-crit) level. The haematocrit level measures how much of the blood is made up of red blood cells. The normal range for haematocrit levels for the general population is 32�43 percent. A low haematocrit level is another sign of anaemia.

The normal range of these levels may be lower in certain racial and ethnic populations. Your doctor can explain your individual test results.

The CBC also checks:

  • The numbers of red blood cells. Too few red blood cells means a person has anaemia. A low number of red blood cells is usually seen with either a low haemoglobin or a low haematocrit level, or both.
  • The numbers of white blood cells. White blood cells are involved in fighting infection.
  • The number of platelets in the blood. Platelets are small cells that are involved in blood clotting.
  • Red blood cell size. The mean cell volume measures the average size (volume) of red blood cells. In iron-deficiency anaemia, the red blood cells are often smaller than normal.

If the CBC results confirm that you have anaemia, your doctor may order additional tests to determine the cause, severity, and correct treatment for your condition. For example, the doctor may order a reticulocyte count. Reticulocytes are young red blood cells. This test measures the number of new red blood cells in your blood. The reticulocyte test is used to determine whether your bone marrow is producing red blood cells at the proper rate.

Tests That Measure Iron Levels in the Body

Iron is needed to make haemoglobin�the protein in red blood cells that gives them their colour and carries oxygen. Several tests can be used to check the level of iron in the blood and in the body:

  • Serum iron. This test measures the amount of iron in the blood. The level of iron in the blood can be normal even when the total amount of iron in the body is low. For this reason, other iron tests are done.
  • Serum ferritin. Ferritin is a protein that helps store iron in the body. Results of this test give doctors a good idea of how much of the body's stored iron has been used up.
  • Transferrin level or total iron-binding capacity. Transferrin is a protein that carries iron in the blood. Total iron-binding capacity measures how much of the transferrin in the blood is not carrying iron. People with iron-deficiency anaemia have a high level of transferrin that has no iron.
  • Other blood tests. Other tests the doctor may order include tests that check hormone levels, especially the thyroid hormone. Blood tests also may be ordered to check the level of a chemical used by the body to make haemoglobin. It is called erythrocyte protoporphyrin.

Tests That Diagnose Gastrointestinal Bleeding

If your doctor suspects anaemia because of internal bleeding in the stomach or intestines, several tests may be used to discover the source of the bleeding.

One of the first tests ordered is the faecal occult blood test. This test checks the stool for signs of blood. It can detect even small amounts of bleeding anywhere in the intestines. If blood is found in the stool, further tests may be used to find the source of the bleeding, including:

  • Colonoscopy. In this test, a thin, flexible tube attached to a video camera is used to examine the rectum and colon for sources of bleeding.
  • Upper GI endoscopy. In this test, a thin, flexible tube attached to a video camera is used to examine the stomach and upper intestines. The doctor looks for signs of bleeding.
  • Pelvic ultrasound. This test uses sound waves to look at the uterus and other pelvic organs. It checks for causes of heavy vaginal bleeding, such as fibroids.

How Is Iron-Deficiency Anaemia Treated?

Goals of Treatment

The goals of treating iron-deficiency anaemia are to restore normal levels of red blood cells, haemoglobin, and iron as well as to treat the condition causing the anaemia.

Specific Types of Treatment

Treatment for iron-deficiency anaemia is based on the cause and the severity of the condition. It will include treatment to stop any bleeding, as well as changes in diet and iron supplements as needed. Severe anaemia may require more emergency measures.

Treatment To Stop Bleeding

Treatment will depend on why the body is bleeding and where it is bleeding. Anaemia will not improve until the bleeding is stopped.

Treatment To Increase Iron in the Diet

Your doctor may recommend a diet rich in iron, folic acid, and vitamin C to treat the anaemia. Iron in meats is more easily absorbed by the body than iron in vegetables and other foods. The best source of iron is red meat, especially beef and liver. Chicken, turkey, pork, fish, and shellfish also are good sources of iron.

Other foods high in iron are:

  • Eggs
  • Cereals, breads, or pastas that are fortified with iron
  • Beans and nuts, including peanut butter, almonds, peas, lentils, and white, red, and baked beans
  • Dried fruits (for example, raisins, apricots, and peaches), prune juice
  • Vegetables such as spinach and other dark green, leafy vegetables
  • Iron-fortified infant formula and cereals

Sources of vitamin C in foods include many fruits and vegetables such as:

  • Citrus fruits (for example, oranges, grapefruits, and lemons) and their juices
  • Kiwi fruit, mangos, apricots, strawberries, cantaloupes, and watermelons
  • Broccoli, peppers, tomatoes, cabbage, potatoes, and leafy greens (for example, romaine lettuce, turnip greens, spinach)

The doctor may prescribe supplements to treat anaemia. Supplements can correct low iron levels within months if taken as ordered. They include iron supplements in pill form and vitamin C to help the body absorb the iron. Iron supplements also come in drops for children. But iron supplements are very dangerous if taken in overdose, so it is important to keep them away from children.

Iron and vitamin C supplements can cause side effects, including dark stools and stomach irritation or heart burn. Iron also can cause constipation, and a stool softener may be needed.

Treatment for Severe and Life-Threatening Anaemia

Severe anaemia may need to be treated with hospitalization, blood transfusions, and iron injections.

How Can Iron-Deficiency Anaemia Be Prevented?

Eating a well-balanced diet rich in iron and vitamins can help prevent iron-deficiency anaemia. Red meat is the best source of iron, but other meats, including poultry and seafood, are good sources of iron as well. Besides meat, foods high in iron are:

  • Eggs
  • Cereals, breads, or pastas that are fortified with iron
  • Beans and nuts, including peanut butter, almonds, peas, lentils, and white, red, and baked beans
  • Dried fruits (for example, raisins, apricots, and peaches), prune juice
  • Vegetables such as spinach and other dark green, leafy vegetables
  • Iron-fortified infant formula and cereals

Food fads and dieting can sometimes lead to iron deficiency. Weight loss diets that stress low-fat foods can mean that a person will avoid animal foods that are good sources of iron. High-fiber diets can make it hard for iron to be absorbed. High-sugar diets are often low in iron.

Adults who eat a balanced diet usually don't need iron supplements. However, people who don't absorb iron well and those who are strict vegetarians may need them.

Preventing Anaemia in Infants and Young Children

Anaemia can be prevented in infants and young children by testing, especially in the following three age groups:

  • Premature and low-birth-weight babies less than 6 months of age
  • Babies who are 9�12 months of age
  • Babies who are 15�18 months of age

Infants absorb iron best from breast milk. They can absorb more than 50 percent of the iron in breast milk but only about 12 percent of the iron in infant formula.

Doctors usually recommend not giving cow's milk to babies for the first year. Cow's milk is low in iron. The doctor may suggest limiting cow's milk for children up to age 3 to no more than 24 ounces a day�about three full baby bottles each day. A child who is drinking a lot of milk may not be eating other foods that are better sources of iron. Drinking a lot of milk also can lead to bleeding in the intestines.

Babies need more iron as they grow and begin to eat solid foods. To help them get enough iron:

  • Infants under age 1 who are not breastfed or who are partially breastfed can be given iron-fortified infant formula. Iron fortified means that each liter of formula has 4�12 milligrams of iron.
  • Babies older than 4 months can be given iron-rich or iron-fortified solid foods such as cereal.

The child's doctor can give advice on the best diet for the infant. The doctor may recommend iron drops if the child needs an iron supplement. Giving a child too much iron can be dangerous, so it is important to be careful and follow the doctor's instructions. Parents and caregivers should keep all iron supplements and vitamins away from children. They should ask for child-proof packages for supplements.

Preventing Anaemia in Adolescents and Women of Childbearing Age

Teenaged girls and women of childbearing age are at higher risk for iron-deficiency anaemia due to blood loss from menstrual bleeding. They should be tested for anaemia every 5�10 years starting in their teens. Girls and women at higher risk for anaemia should be checked yearly. This includes women who have a history of anaemia, do not eat foods high in iron, or have heavy blood loss from menstruation or other causes.

Preventing Anaemia in Pregnant Women

Half of all pregnant women develop iron-deficiency anaemia because their volume of blood increases and because the growing foetus needs iron. Anaemia during pregnancy can lead to an increased risk of premature delivery and a low-birth-weight baby.

To prevent these problems, pregnant women need twice as much iron as women who are not pregnant. Pregnant women can get more iron from eating more iron-rich foods, from supplements, or from both. Medical care during pregnancy should include screening for anaemia.

The doctor giving prenatal care may prescribe iron supplements, which should be taken as directed. Pregnant women should notify their doctors if they have uncomfortable side effects such as constipation. The doctor also may give advice on how to get higher levels of iron through eating iron-rich foods.

Preventing Anaemia in Older Adults

Older adults may be at risk for iron deficiency due to poor diet or illnesses that reduce iron absorption. Iron deficiency can take away their sense of well-being, strength, and activeness. It also can make symptoms of other conditions worse. Doctors can advise older adults about eating iron-rich foods and how to use iron supplements to prevent iron-deficiency anaemia.

Living With Iron-Deficiency Anaemia

If you have iron-deficiency anaemia, you need to see a doctor for treatment but you can recover, feel well, and live a normal life.

Ongoing Health Care Needs

You will need regular medical checkups to make sure your iron levels are going up. At your checkups you may have changes made to your medicines or supplements, or you may get further advice on a healthy diet.

During treatment for anaemia, you may feel fatigue (tiredness) and have other symptoms until your iron levels return to normal. This can take months. Tell your doctor if you get any new symptoms or if your symptoms get worse.

Take iron supplements only with your doctor's approval. Don't decide to take them on your own. It is possible to get too high a level of iron in your body and cause a condition called iron overload.

A pregnant woman with iron-deficiency anaemia is usually tested for anaemia at 4�6 weeks after delivery, if she:

  • Was anemic during the third trimester of pregnancy
  • Lost a lot of blood during childbirth
  • Had a multiple birth (such as twins)

Key Points

  • Iron-deficiency anaemia is an illness that occurs when there is not enough iron in the body.
  • Iron helps the body make haemoglobin and healthy red blood cells. Haemoglobin is needed to carry oxygen throughout the body.
  • A person can have low iron levels for three reasons: blood loss, either from disease or injury; not getting enough iron in the diet; and not being able to absorb the iron in the diet. Iron-deficiency anaemia also can develop when the body needs higher levels of iron, such as during pregnancy.
  • One in five women of childbearing age and half of all pregnant women have iron-deficiency anaemia.
  • Infants and toddlers can be at risk for iron-deficiency anaemia.
  • The most common symptoms of iron-deficiency anaemia are fatigue (tiredness) and weakness.
  • Iron-deficiency anaemia is treated by stopping the bleeding (if the cause of the anaemia is bleeding), increasing iron in the diet, and giving iron supplements.
  • Eating a well-balanced diet rich in iron and vitamins can help prevent iron deficiency anaemia.
  • Iron-deficiency anaemia can be successfully treated


Infant formula is a modern artificial substitute for human breast milk. Formulas are designed for infant consumption, and are usually based on either cow milk or soy milk. Use of infant formula has been decreasing in industrial countries for over forty years as a result of antenatal education, increased understanding of the risks of infant formula, and social activism. Most major medical and health organizations strongly advocate breastfeeding over the use of infant formula.

Besides breast milk, infant formula is the only other infant milk which the medical community considers nutritionally acceptable for infants under the age of one year. Cow's milk is not recommended because of its high protein and electrolyte (salt) content which may put a strain on an infant's immature kidneys. Evaporated milk, although perhaps easier to digest due to the processing of the protein, is still nutritionally inadequate.

Infant formula is available in powder, liquid concentrate and ready-to-feed forms, which are prepared by the caregiver or parent in small batches and fed to the infant, usually with either a baby bottle or cup. It is very important to measure powders or concentrates accurately to achieve the intended final product. It is advisable that all equipment that comes into contact with the infant formula be cleaned and sterilized before each use. Proper refrigeration is essential for any infant formula which is prepared in advance, since infant formula is especially susceptible to bacterial growth. Powdered, cow's milk-based infant formulas are not recommended for premature or sick infants, or for infants under one month of age. Powdered infant formulas are not sterile and may be contaminated with Enterobacter sakazakii, bacteria that may lead to neonatal meningitis, sepsis and necrotizing entercolitis in infants with weak or compromised immune systems.


A high level of blood serum homocysteine is considered to be a marker of potential cardiovascular (risk factor for heart attack and stroke) disease. A current area of research is whether high serum homocysteine itself is a problem or merely an indicator of existing problems.

Studies reported in 2006 have shown that giving vitamins [folic acid, B6 and B12] to reduce homocysteine levels may not quickly offer benefit. However a significant 25% reduction in stroke was found in the HOPE-2 study even in patients mostly with existing serious arterial decline although the overall death rate was not significantly changed by the intervention in the trial. Clearly, reducing homocysteine does not quickly repair existing structural damage of the artery architecture. However, the science is strong supporting the biochemistry that homocysteine degrades and inhibits the formation of the three main structural components of the artery, collagen, elastin and the proteoglycans. Homocysteine permanently degrades cysteine [disulfide bridges] and lysine amino acid residues in proteins, gradually affecting function and structure. Simply put, homocysteine is a 'corrosive' of long-living [collagen, elastin] or life-long proteins [fibrillin]. These long-term effects are difficult to establish in clinical trials focusing on groups with existing artery decline. The main role of reducing homocysteine is likely in 'prevention' but with a slow but probable role in 'cure'.


What is food poisoning (foodborne disease)?

Food poisoning (foodborne disease) is caused by consuming contaminated foods or beverages. Many different disease-causing microbes, or pathogens, can contaminate foods, so there are many different foodborne infections. In addition, poisonous chemicals, or other harmful substances can cause foodborne diseases if they are present in food.

More than 250 different foodborne diseases have been described. Most of these diseases are infections, caused by a variety of bacteria, viruses, and parasites that can be foodborne. Other diseases are poisonings, caused by harmful toxins or chemicals that have contaminated the food, for example, poisonous mushrooms. These different diseases have many different symptoms, so there is no one "syndrome" that is foodborne illness. However, the microbe or toxin enters the body through the gastrointestinal tract, and often causes the first symptoms there, so nausea, vomiting, abdominal cramps and diarrhoea are common symptoms in many foodborne diseases.

Many microbes can spread in more than one way, so we cannot always know that a disease is foodborne. The distinction matters, because public health authorities need to know how a particular disease is spreading to take the appropriate steps to stop it. For example, Escherichia coli O157:H7 infections can spread through contaminated food, contaminated drinking water, contaminated swimming water, and from toddler to toddler at a day care center. Depending on which means of spread caused a case, the measures to stop other cases from occurring could range from removing contaminated food from stores, chlorinating a swimming pool, or closing a child day care center.

What are the most common foodborne diseases?

The most commonly recognised foodborne infections are those caused by the bacteria Campylobacter, Salmonella, and E. coli O157:H7, and by a group of viruses called calicivirus, also known as the Norwalk and Norwalk-like viruses.

Campylobacter is a bacterial pathogen that causes fever, diarrhoea, and abdominal cramps. It is the most commonly identified bacterial cause of diarrhoeal illness in the world. These bacteria live in the intestines of healthy birds, and most raw poultry meat has Campylobacter on it. Eating undercooked chicken, or other food that has been contaminated with juices dripping from raw chicken is the most frequent source of this infection.

Salmonella is also a bacterium that is widespread in the intestines of birds, reptiles and mammals. It can spread to humans via a variety of different foods of animal origin. The illness it causes, salmonellosis, typically includes fever, diarrhoea and abdominal cramps. In persons with poor underlying health or weakened immune systems, it can invade the bloodstream and cause life-threatening infections.

E. coli O157:H7 is a bacterial pathogen that has a reservoir in cattle and other similar animals. Human illness typically follows consumption of food or water that has been contaminated with microscopic amounts of cow feces. The illness it causes is often a severe and bloody diarrhoea and painful abdominal cramps, without much fever. In 3% to 5% of cases, a complication called haemolytic uraemic syndrome (HUS) can occur several weeks after the initial symptoms. This severe complication includes temporary anaemia, profuse bleeding, and kidney failure.

Calicivirus, or Norwalk-like virus is an extremely common cause of foodborne illness, though it is rarely diagnosed, because the laboratory test is not widely available. It causes an acute gastrointestinal illness, usually with more vomiting than diarrhoea, that resolves within two days. Unlike many foodborne pathogens that have animal reservoirs, it is believed that Norwalk-like viruses spread primarily from one infected person to another. Infected kitchen workers can contaminate a salad or sandwich as they prepare it, if they have the virus on their hands. Infected fishermen have contaminated oysters as they harvested them.

Some common diseases are occasionally foodborne, even though they are usually transmitted by other routes. These include infections caused by Shigella, hepatitis A, and the parasites Giardia lamblia and Cryptosporidia. Even strep throats have been transmitted occasionally through food.

In addition to disease caused by direct infection, some foodborne diseases are caused by the presence of a toxin in the food that was produced by a microbe in the food. For example, the bacterium Staphylococcus aureus can grow in some foods and produce a toxin that causes intense vomiting. The rare but deadly disease botulism occurs when the bacterium Clostridium botulinum grows and produces a powerful paralytic toxin in foods. These toxins can produce illness even if the microbes that produced them are no longer there.

Other toxins and poisonous chemicals can cause foodborne illness. People can become ill if a pesticide is inadvertently added to a food, or if naturally poisonous substances are used to prepare a meal. Every year, people become ill after mistaking poisonous mushrooms for safe species, or after eating poisonous reef fishes.

What happens in the body after the microbes that produce illness are swallowed?

After they are swallowed, there is a delay, called the incubation period, before the symptoms of illness begin. This delay may range from hours to days, depending on the organism, and on how many of them were swallowed. During the incubation period, the microbes pass through the stomach into the intestine, attach to the cells lining the intestinal walls, and begin to multiply there. Some types of microbes stay in the intestine, some produce a toxin that is absorbed into the bloodstream, and some can directly invade the deeper body tissues. The symptoms produced depend greatly on the type of microbe. Numerous organisms cause similar symptoms, especially diarrhoea, abdominal cramps, and nausea. There is so much overlap that it is rarely possible to say which microbe is likely to be causing a given illness unless laboratory tests are done to identify the microbe, or unless the illness is part of a recognised outbreak.

How are foodborne diseases diagnosed?

The infection is usually diagnosed by specific laboratory tests that identify the causative organism. Bacteria such as Campylobacter, Salmonella, E. coli O157 are found by culturing stool samples in the laboratory and identifying the bacteria that grow on the agar or other culture medium. Parasites can be identified by examining stools under the microscope. Viruses are more difficult to identify, as they are too small to see under a light microscope and are difficult to culture. Viruses are usually identified by testing stool samples for genetic markers that indicate a specific virus is present.

Many foodborne infections are not identified by routine laboratory procedures and require specialized, experimental, and/or expensive tests that are not generally available. If the diagnosis is to be made, the patient has to seek medical attention, the physician must decide to order diagnostic tests, and the laboratory must use the appropriate procedures. Because many ill persons to not seek attention, and of those that do, many are not tested, many cases of foodborne illness go undiagnosed. For example, CDC estimates that 38 cases of salmonellosis actually occur for every case that is actually diagnosed and reported to public health authorities.

How are foodborne diseases treated?

There are many different kinds of foodborne diseases and they may require different treatments, depending on the symptoms they cause. Illnesses that are primarily diarrhoea or vomiting can lead to dehydration if the person loses more body fluids and salts (electrolytes) than they take in. Replacing the lost fluids and electrolytes and keeping up with fluid intake are important. If diarrhoea is severe, oral rehydration solution such as Ceralyte

  • , Pedialyte
  • or Oralyte
  • , should be drunk to replace the fluid losses and prevent dehydration. Sports drinks such as Gatorade
  • do not replace the losses correctly and should not be used for the treatment of diarrhoeal illness. Preparations of bismuth subsalicylate (e.g., Pepto-Bismol)
  • can reduce the duration and severity of simple diarrhoea. If diarrhoea and cramps occur, without bloody stools or fever, taking an antidiarrhoeal medication may provide symptomatic relief, but these medications should be avoided if there is high fever or blood in the stools because they may make the illness worse.
  • When should I consult my doctor about a diarrhoeal illness?

    A health care provider should be consulted for a diarrhoeal illness is accompanied by

    • high fever (temperature over 101.5 F, measured orally)
    • blood in the stools
    • prolonged vomiting that prevents keeping liquids down (which can lead to dehydration)
    • signs of dehydration, including a decrease in urination, a dry mouth and throat, and feeling dizzy when standing up.
    • diarrhoeal illness that lasts more than 3 days

    Do not be surprised if your doctor does not prescribe an antibiotic. Many diarrhoeal illnesses are caused by viruses and will improve in 2 or 3 days without antibiotic therapy. In fact, antibiotics have no effect on viruses, and using an antibiotic to treat a viral infection could cause more harm than good It is often not necessary to take an antibiotic even in the case of a mild bacterial infection. Other treatments can help the symptoms, and careful handwashing can prevent the spread of infection to other people. Overuse of antibiotics is the principal reason many bacteria are becoming resistant. Resistant bacteria are no longer killed by the antibiotic. This means that it is important to use antibiotics only when they are really needed. Partial treatment can also cause bacteria to become resistant. If an antibiotic is prescribed, it is important to take all of the medication as prescribed, and not stop early just because the symptoms seem to be improving.


    Food allergies or food intolerances affect nearly everyone at some point. People often have an unpleasant reaction to something they ate and wonder if they have a food allergy. One out of three people either say that they have a food allergy or that they modify the family diet because a family member is suspected of having a food allergy. But only about three percent of children have clinically proven allergic reactions to foods. In adults, the prevalence of food allergy drops to about one percent of the total population.

    This difference between the clinically proven prevalence of food allergy and the public perception of the problem is in part due to reactions called "food intolerances" rather than food allergies. A food allergy, or hypersensitivity, is an abnormal response to a food that is triggered by the immune system. The immune system is not responsible for the symptoms of a food intolerance, even though these symptoms can resemble those of a food allergy.

    It is extremely important for people who have true food allergies to identify them and prevent allergic reactions to food because these reactions can cause devastating illness and, in some cases, be fatal.

    How Allergic Reactions Work

    An allergic reaction involves two features of the human immune response. One is the production of immunoglobulin E (IgE), a type of protein called an antibody that circulates through the blood. The other is the mast cell, a specific cell that occurs in all body tissues but is especially common in areas of the body that are typical sites of allergic reactions, including the nose and throat, lungs, skin, and gastrointestinal tract.

    The ability of a given individual to form IgE against something as benign as food is an inherited predisposition. Generally, such people come from families in which allergies are common�not necessarily food allergies but perhaps hay fever, asthma, or hives. Someone with two allergic parents is more likely to develop food allergies than someone with one allergic parent.

    Before an allergic reaction can occur, a person who is predisposed to form IgE to foods first has to be exposed to the food. As this food is digested, it triggers certain cells to produce specific IgE in large amounts. The IgE is then released and attaches to the surface of mast cells. The next time the person eats that food, it interacts with specific IgE on the surface of the mast cells and triggers the cells to release chemicals such as histamine. Depending upon the tissue in which they are released, these chemicals will cause a person to have various symptoms of food allergy. If the mast cells release chemicals in the ears, nose, and throat, a person may feel an itching in the mouth and may have trouble breathing or swallowing. If the affected mast cells are in the gastrointestinal tract, the person may have abdominal pain or diarrhoea. The chemicals released by skin mast cells, in contrast, can prompt hives.

    Food allergens (the food fragments responsible for an allergic reaction) are proteins within the food that usually are not broken down by the heat of cooking or by stomach acids or enzymes that digest food. As a result, they survive to cross the gastrointestinal lining, enter the bloodstream, and go to target organs, causing allergic reactions throughout the body.

    The complex process of digestion affects the timing and the location of a reaction. If people are allergic to a particular food, for example, they may first experience itching in the mouth as they start to eat the food. After the food is digested in the stomach, abdominal symptoms such as vomiting, diarrhoea, or pain may start. When the food allergens enter and travel through the bloodstream, they can cause a drop in blood pressure. As the allergens reach the skin, they can induce hives or eczema, or when they reach the lungs, they may cause asthma. All of this takes place within a few minutes to an hour.

    Common Food Allergies

    In adults, the most common foods to cause allergic reactions include: shellfish such as shrimp, crayfish, lobster, and crab; peanuts, a legume that is one of the chief foods to cause severe anaphylaxis, a sudden drop in blood pressure that can be fatal if not treated quickly; tree nuts such as walnuts; fish; and eggs.

    In children, the pattern is somewhat different. The most common food allergens that cause problems in children are eggs, milk, and peanuts. Adults usually do not lose their allergies, but children can sometimes outgrow them. Children are more likely to outgrow allergies to milk or soy than allergies to peanuts, fish, or shrimp.

    The foods that adults or children react to are those foods they eat often. In Japan, for example, rice allergy is more frequent. In Scandinavia, codfish allergy is more common.

    Cross Reactivity

    If someone has a life-threatening reaction to a certain food, the doctor will counsel the patient to avoid similar foods that might trigger this reaction. For example, if someone has a history of allergy to shrimp, testing will usually show that the person is not only allergic to shrimp but also to crab, lobster, and crayfish as well. This is called cross-reactivity.

    Another interesting example of cross-reactivity occurs in people who are highly sensitive to ragweed. During ragweed pollination season, these people sometimes find that when they try to eat melons, particularly cantaloupe, they have itching in their mouth and they simply cannot eat the melon. Similarly, people who have severe birch pollen allergy also may react to the peel of apples. This is called the "oral allergy syndrome."

    Differential Diagnoses

    A differential diagnosis means distinguishing food allergy from food intolerance or other illnesses. If a patient goes to the doctor's office and says, "I think I have a food allergy," the doctor has to consider the list of other possibilities that may lead to symptoms that could be confused with food allergy.

    One possibility is the contamination of foods with microorganisms, such as bacteria, and their products, such as toxins. Contaminated meat sometimes mimics a food reaction when it is really a type of food poisoning.

    There are also natural substances, such as histamine, that can occur in foods and stimulate a reaction similar to an allergic reaction. For example, histamine can reach high levels in cheese, some wines, and in certain kinds of fish, particularly tuna and mackerel. In fish, histamine is believed to stem from bacterial contamination, particularly in fish that hasn't been refrigerated properly. If someone eats one of these foods with a high level of histamine, that person may have a reaction that strongly resembles an allergic reaction to food. This reaction is called histamine toxicity.

    Another cause of food intolerance that is often confused with a food allergy is lactase deficiency. This most common food intolerance affects at least one out of ten people. Lactase is an enzyme that is in the lining of the gut. This enzyme degrades lactose, which is in milk. If a person does not have enough lactase, the body cannot digest the lactose in most milk products. Instead, the lactose is used by bacteria, gas is formed, and the person experiences bloating, abdominal pain, and sometimes diarrhoea. There are a couple of diagnostic tests in which the patient ingests a specific amount of lactose and then the doctor measures the body's response by analyzing a blood sample.

    Another type of food intolerance is an adverse reaction to certain products that are added to food to enhance taste, provide color, or protect against the growth of microorganisms. Compounds that are most frequently tied to adverse reactions that can be confused with food allergy are yellow dye number 5, monosodium glutamate, and sulfites. Yellow dye number 5 can cause hives, although rarely. Monosodium glutamate (MSG) is a flavor enhancer, and, when consumed in large amounts, can cause flushing, sensations of warmth, headache, facial pressure, chest pain, or feelings of detachment in some people. These transient reactions occur rapidly after eating large amounts of food to which MSG has been added.

    Sulfites can occur naturally in foods or are added to enhance crispness or prevent mold growth. Sulfites in high concentrations sometimes pose problems for people with severe asthma. Sulfites can give off a gas called sulfur dioxide, which the asthmatic inhales while eating the sulfited food. This irritates the lungs and can send an asthmatic into severe bronchospasm, a constriction of the lungs. Such reactions led the U.S. Food and Drug Administration (FDA) to ban sulfites as spray-on preservatives in fresh fruits and vegetables. But they are still used in some foods and are made naturally during the fermentation of wine, for example.

    There are several other diseases that share symptoms with food allergies including ulcers and cancers of the gastrointestinal tract. These disorders can be associated with vomiting, diarrhoea, or cramping abdominal pain exacerbated by eating.

    Gluten intolerance is associated with the disease called gluten-sensitive enteropathy or celiac disease. It is caused by an abnormal immune response to gluten, which is a component of wheat and some other grains.

    Some people may have a food intolerance that has a psychological trigger. In selected cases, a careful psychiatric evaluation may identify an unpleasant event in that person's life, often during childhood, tied to eating a particular food. The eating of that food years later, even as an adult, is associated with a rush of unpleasant sensations that can resemble an allergic reaction to food.


    To diagnose food allergy a doctor must first determine if the patient is having an adverse reaction to specific foods. This assessment is made with the help of a detailed patient history, the patient's diet diary, or an elimination diet.

    The first of these techniques is the most valuable. The physician sits down with the person suspected of having a food allergy and takes a history to determine if the facts are consistent with a food allergy. The doctor asks such questions as:

    • What was the timing of the reaction? Did the reaction come on quickly, usually within an hour after eating the food?
    • Was allergy treatment successful? (Antihistamines should relieve hives, for example, if they stem from a food allergy.)
    • Is the reaction always associated with a certain food?
    • Did anyone else get sick? For example, if the person has eaten fish contaminated with histamine, everyone who ate the fish should be sick. In an allergic reaction, however, only the person allergic to the fish becomes ill.
    • How much did the patient eat before experiencing a reaction? The severity of the patient's reaction is sometimes related to the amount of food the patient ate.
    • How was the food prepared? Some people will have a violent allergic reaction only to raw or undercooked fish. Complete cooking of the fish destroys those allergens in the fish to which they react. If the fish is cooked thoroughly, they can eat it with no allergic reaction.
    • Were other foods ingested at the same time of the allergic reaction? Some foods may delay digestion and thus delay the onset of the allergic reaction.

    Sometimes a diagnosis cannot be made solely on the basis of history. In that case, the doctor may ask the patient to go back and keep a record of the contents of each meal and whether he or she had a reaction. This gives more detail from which the doctor and the patient can determine if there is consistency in the reactions.

    The next step some doctors use is an elimination diet. Under the doctor's direction, the patient does not eat a food suspected of causing the allergy, like eggs, and substitutes another food, in this case, another source of protein. If the patient removes the food and the symptoms go away, the doctor can almost always make a diagnosis. If the patient then eats the food (under the doctor's direction) and the symptoms come back, then the diagnosis is confirmed. This technique cannot be used, however, if the reactions are severe (in which case the patient should not resume eating the food) or infrequent.

    If the patient's history, diet diary, or elimination diet suggests a specific food allergy is likely, the doctor will then use tests that can more objectively measure an allergic response to food. One of these is a scratch skin test, during which a dilute extract of the food is placed on the skin of the forearm or back. This portion of the skin is then scratched with a needle and observed for swelling or redness that would indicate a local allergic reaction. If the scratch test is positive, the patient has IgE on the skin's mast cells that is specific to the food being tested.

    Skin tests are rapid, simple, and relatively safe. But a patient can have a positive skin test to a food allergen without experiencing allergic reactions to that food. A doctor diagnoses a food allergy only when a patient has a positive skin test to a specific allergen and the history of these reactions suggests an allergy to the same food.

    In some extremely allergic patients who have severe anaphylactic reactions, skin testing cannot be used because it could evoke a dangerous reaction. Skin testing also cannot be done on patients with extensive eczema.

    For these patients a doctor may use blood tests such as the RAST and the ELISA. These tests measure the presence of food-specific IgE in the blood of patients. These tests may cost more than skin tests, and results are not available immediately. As with skin testing, positive tests do not necessarily make the diagnosis.

    The final method used to objectively diagnose food allergy is double-blind food challenge. This testing has come to be the "gold standard" of allergy testing. Various foods, some of which are suspected of inducing an allergic reaction, are each placed in individual opaque capsules. The patient is asked to swallow a capsule and is then watched to see if a reaction occurs. This process is repeated until all the capsules have been swallowed. In a true double-blind test, the doctor is also "blinded" (the capsules having been made up by some other medical person) so that neither the patient nor the doctor knows which capsule contains the allergen.

    The advantage of such a challenge is that if the patient has a reaction only to suspected foods and not to other foods tested, it confirms the diagnosis. Someone with a history of severe reactions, however, cannot be tested this way. In addition, this testing is expensive because it takes a lot of time to perform and multiple food allergies are difficult to evaluate with this procedure.

    Consequently, double-blind food challenges are done infrequently. This type of testing is most commonly used when the doctor believes that the reaction a person is describing is not due to a specific food and the doctor wishes to obtain evidence to support this judgment so that additional efforts may be directed at finding the real cause of the reaction. Exercise-Induced Food Allergy At least one situation may require more than the simple ingestion of a food allergen to provoke a reaction: exercise-induced food allergy. People who experience this reaction eat a specific food before exercising. As they exercise and their body temperature goes up, they begin to itch, get light-headed, and soon have allergic reactions such as hives or even anaphylaxis. The cure for exercised-induced food allergy is simple�not eating for a couple of hours before exercising.


    Food allergy is treated by dietary avoidance. Once a patient and the patient's doctor have identified the food to which the patient is sensitive, the food must be removed from the patient's diet. To do this, patients must read lengthy, detailed ingredient lists on each food they are considering eating. Many allergy-producing foods such as peanuts, eggs, and milk, appear in foods one normally would not associate them with. Peanuts, for example, are often used as a protein source and eggs are used in some salad dressings. The FDA requires ingredients in a food to appear on its label. People can avoid most of the things to which they are sensitive if they read food labels carefully and avoid restaurant-prepared foods that might have ingredients to which they are allergic.

    In highly allergic people even minuscule amounts of a food allergen (for example, 1/44,000 of a peanut kernel) can prompt an allergic reaction. Other less sensitive people may be able to tolerate small amounts of a food to which they are allergic.

    Patients with severe food allergies must be prepared to treat an inadvertent exposure. Even people who know a lot about what they are sensitive to occasionally make a mistake. To protect themselves, people who have had anaphylactic reactions to a food should wear medical alert bracelets or necklaces stating that they have a food allergy and that they are subject to severe reactions. Such people should always carry a syringe of adrenaline (epinephrine), obtained by prescription from their doctors, and be prepared to self-administer it if they think they are getting a food allergic reaction. They should then immediately seek medical help by either calling the rescue squad or by having themselves transported to an emergency room. Anaphylactic allergic reactions can be fatal even when they start off with mild symptoms such as a tingling in the mouth and throat or gastrointestinal discomfort.

    Special precautions are warranted with children. Parents and caregivers must know how to protect children from foods to which the children are allergic and how to manage the children if they consume a food to which they are allergic, including the administration of epinephrine. Schools must have plans in place to address any emergency.

    There are several medications that a patient can take to relieve food allergy symptoms that are not part of an anaphylactic reaction. These include antihistamines to relieve gastrointestinal symptoms, hives, or sneezing and a runny nose. Bronchodilators can relieve asthma symptoms. These medications are taken after people have inadvertently ingested a food to which they are allergic but are not effective in preventing an allergic reaction when taken prior to eating the food. No medication in any form can be taken before eating a certain food that will reliably prevent an allergic reaction to that food.

    There are a few non-approved treatments for food allergies. One involves injections containing small quantities of the food extracts to which the patient is allergic. These shots are given on a regular basis for a long period of time with the aim of "desensitizing" the patient to the food allergen. Researchers have not yet proven that allergy shots relieve food allergies.

    Infants and Children

    Milk and soy allergies are particularly common in infants and young children. These allergies sometimes do not involve hives and asthma, but rather lead to colic, and perhaps blood in the stool or poor growth. Infants and children are thought to be particularly susceptible to this allergic syndrome because of the immaturity of their immune and digestive systems. Milk or soy allergies in infants can develop within days to months of birth. Sometimes there is a family history of allergies or feeding problems. The clinical picture is one of a very unhappy colicky child who may not sleep well at night. The doctor diagnoses food allergy partly by changing the child's diet. Rarely, food challenge is used.

    If the baby is on cow's milk, the doctor may suggest a change to soy formula or exclusive breast milk, if possible. If soy formula causes an allergic reaction, the baby may be placed on an elemental formula. These formulas are processed proteins (basically sugars and amino acids). There are few if any allergens within these materials. The doctor will sometimes prescribe corticosteroids to treat infants with severe food allergies. Fortunately, time usually heals this particular gastrointestinal disease. It tends to resolve within the first few years of life.

    Exclusive breast feeding (excluding all other foods) of infants for the first 6 to 12 months of life is often suggested to avoid milk or soy allergies from developing within that time frame. Such breast feeding often allows parents to avoid infant-feeding problems, especially if the parents are allergic (and the infant therefore is likely to be allergic). There are some children who are so sensitive to a certain food, however, that if the food is eaten by the mother, sufficient quantities enter the breast milk to cause a food reaction in the child. Mothers sometimes must themselves avoid eating those foods to which the baby is allergic.

    There is no conclusive evidence that breast feeding prevents the development of allergies later in life. It does, however, delay the onset of food allergies by delaying the infant's exposure to those foods that can prompt allergies, and it may avoid altogether those feeding problems seen in infants. By delaying the introduction of solid foods until the infant is 6 months old or older, parents can also prolong the child's allergy-free period.

    Controversial Issues

    There are several disorders thought by some to be caused by food allergies, but the evidence is currently insufficient or contrary to such claims. It is controversial, for example, whether migraine headaches can be caused by food allergies. There are studies showing that people who are prone to migraines can have their headaches brought on by histamines and other substances in foods. The more difficult issue is whether food allergies actually cause migraines in such people. There is virtually no evidence that most rheumatoid arthritis or osteoarthritis can be made worse by foods, despite claims to the contrary. There is also no evidence that food allergies can cause a disorder called the allergic tension fatigue syndrome, in which people are tired, nervous, and may have problems concentrating, or have headaches.

    Cerebral allergy is a term that has been applied to people who have trouble concentrating and have headaches as well as other complaints. This is sometimes attributed to mast cells degranulating in the brain but no other place in the body. There is no evidence that such a scenario can happen, and most doctors do not currently recognize cerebral allergy as a disorder.

    Another controversial topic is environmental illness. In a seemingly pristine environment, some people have many non-specific complaints such as problems concentrating or depression. Sometimes this is attributed to small amounts of allergens or toxins in the environment. There is no evidence that such problems are due to food allergies.

    Some people believe hyperactivity in children is caused by food allergies. But researchers have found that this behavioral disorder in children is only occasionally associated with food additives, and then only when such additives are consumed in large amounts. There is no evidence that a true food allergy can affect a child's activity except for the proviso that if a child itches and sneezes and wheezes a lot, the child may be miserable and therefore more difficult to guide. Also, children who are on anti-allergy medicines that can cause drowsiness may get sleepy in school or at home.

    Controversial Diagnostic Techniques

    One controversial diagnostic technique is cytotoxicity testing, in which a food allergen is added to a patient's blood sample. A technician then examines the sample under the microscope to see if white cells in the blood "die." Scientists have evaluated this technique in several studies and have not been found it to effectively diagnose food allergy.

    Another controversial approach is called sublingual or, if it is injected under the skin, subcutaneous provocative challenge. In this procedure, dilute food allergen is administered under the tongue of the person who may feel that his or her arthritis, for instance, is due to foods. The technician then asks the patient if the food allergen has aggravated the arthritis symptoms. In clinical studies, researchers have not shown that this procedure can effectively diagnose food allergies.

    An immune complex assay is sometimes done on patients suspected of having food allergies to see if there are complexes of certain antibodies bound to the food allergen in the bloodstream. It is said that these immune complexes correlate with food allergies. But the formation of such immune complexes is a normal offshoot of food digestion, and everyone, if tested with a sensitive enough measurement, has them. To date, no one has conclusively shown that this test correlates with allergies to foods.

    Another test is the IgG subclass assay, which looks specifically for certain kinds of IgG antibody. Again, there is no evidence that this diagnoses food allergy.

    Controversial Treatments

    Controversial treatments include putting a dilute solution of a particular food under the tongue about a half hour before the patient eats that food. This is an attempt to "neutralise" the subsequent exposure to the food that the patient believes is harmful. As the results of a carefully conducted clinical study show, this procedure is not effective in preventing an allergic reaction.


    Food allergies are caused by immunologic reactions to foods. There actually are several discrete diseases under this category, and a number of foods that can cause these problems.

    After one suspects a food allergy, a medical evaluation is the key to proper management. Treatment is basically avoiding the food(s) after it is identified. People with food allergies should become knowledgeable about allergies and how they are treated, and should work with their physicians.


    What is folic acid?

    Folic acid is a B vitamin. Folic acid helps the body make healthy new cells.

    Why should women take folic acid?

    All women need folic acid. When a woman has enough folic acid before and during pregnancy, it can help prevent major birth defects of her baby's brain or spine.

    Be sure to get enough folic acid every day. Start before you are pregnant. Folic acid is needed during the first few weeks, often before a woman knows she is pregnant. And half of all pregnancies in the U.S. are not planned. That is why it's so important to start taking folic acid each day, even when you are not planning to get pregnant.

    Folic acid might also have other benefits for men and women of any age. Some studies show that folic acid might help prevent heart disease, stroke, some cancers, and possibly Alzheimer's disease.

    How can women get folic acid?

    All women should aim to get at least 400 micrograms (400 mcg) of folic acid each day. There are a few easy ways she can do this.

    • Take a daily vitamin that has folic acid in it. Most multivitamins sold in the U.S. have enough. Check the label on the vitamin to be sure. It should say �400 mcg� or �100%� next to folic acid. Some labels might use the word �folate� for folic acid. Or you can take a vitamin pill that only has folic acid in it. You can find both of these types at your local grocery, drug store, or discount store.
    • Another way to get enough folic acid is to eat a serving of breakfast cereal that contains 100% of the daily value (DV) for folic acid each day. Check the label on the box to be sure it has enough.
    • Eat a healthy diet that contains lots of fruits and vegetables and other foods that have folic acid (or folate) in them or added to them. Foods that contain folic acid (or folate) include broccoli, asparagus, bananas, oranges, peas, nuts, bread, cereal, and flour.
    How much folic acid should you take?

    Read the descriptions below to see how much folic acid you should take. Check off the one that applies to you.

    You are able to get pregnant. Take 400 mcg of folic acid every day.
    You are pregnant. Take 600mcg of folic acid every day.
    You are breastfeeding. Take 500mcg of folic acid every day.
    You had a baby with spina bifida or anencephaly and want to get pregnant again. Talk with your doctor, and ask for a prescription for a higher dose of folic acid. You should take 4,000 micrograms (4,000 mcg) starting at least one to three months before getting pregnant and during the first 3 months of pregnancy. That's 10 times the normal amount! But don't try to get the larger amount by taking more than one multivitamin or prenatal vitamin a day. You could get too much of another vitamin that could harm you or your baby.
    You had a baby with spina bifida or anencephaly. You are not planning to have another baby. Take 400 mcg of folic acid every day.


    Fibre is characterized by carbohydrates that can not be fully broken down and digested by your body. Fibre may not contain any calories, vitamins, and minerals but it is very important for your health.

    Fibre can only be found in plants, particularly their cell walls. Food from animals like meat, fish, dairy products, and eggs contain no fibre. Fibre is composed of several complex carbohydrates. Fibre can be classified into two types. The first type is insoluble. This type of fibre passes through your digestive system without being digested. The second type of fibre is the soluble fibre. This kind of fibre is digested and broken down with bacteria when it reaches the large bowel.

    What are fibre’s functions?

    Fibre is basically used for roughage, meaning, it is needed for the proper functioning of your bowel. As fibre passes through your bowel, it absorbs water and makes waste matter more bulky. At the same time, the waste becomes softer. As a result, the waste passes through your bowel faster and easier than usual.

    What is the importance of fibre?

    When you have a lot of fibre in your diet, you will have several health benefits. It will reduce the occurrence of bowel related problems. Some of the bowel problems that you will prevent are constipation, diverticular disease or when the bowel wall becomes inflamed and damaged, and colon cancer or large bowel cancer.

    Soluble fibre keeps your blood sugar levels stable. This is because it can slow down the rate of absorption of glucose in your blood stream. If you are diabetic then this is very important to know. With fibre, you also keep your blood cholesterol levels low and thus, minimizing your risk of getting heart problems.

    Fibre also allows you to feel full so that you don’t overeat. If you are trying to lose weight then fibre is important. Fibre allows you to control your appetite.

    How much fibre should you consume?

    The average adult should consume around eighteen grams of fibre every day. This refers to one type of fibre that we consume and it is the non-starch polysaccharides type or NSP. Right now, this recommendation is being reviewed because some experts believe that the average adult should have several other types of fibre in their diet as well. If their claims are true then the average adult will be required to consume about twenty four grams of fibre every day. There are also studies that show that fibre intake must be increased to thirty grams every day in order to maintain good health.

    In the United Kingdom, the average person only consumes twelve grams of fibre every day. This is too little. People from the United Kingdom should not be surprised if ten to twenty percent of the population has some sort of constipation problem.

    It is wise to increase your fibre intake in your diet slowly. This is because if you suddenly increase your diet with fibre, you may experience stomach cramps, wind, and bloating. In line with increasing your intake of fibre, you must also increase your intake of fluids because the fibre needs to absorb fluids during digestion.

    Overdose of fibre can also be harmful to your body. If you have too much fibre in your body, then essential vitamins and nutrients may not be absorbed anymore. Your body may lose its ability to absorb minerals and valuable nutrients.

    What are some foods that have fibre?

    All foods that are plant based have fibre in them. They only differ in the amount of fibre they have. Foods that are rich in fibre include fruits, vegetables, wholegrain rice, wholegrain pasta, whole meal bread, nuts, seeds, bran, and wholegrain breakfast cereals. If you want to consume foods that are rich in soluble fibre then consider eating fruits, vegetables, lentils, beans, and outs. If you want to consume insoluble fibre then eat foods like whole meal bread, brown rice, fruits, vegetables, and wholegrain breakfast cereals.

    When you go shopping, make sure you look at the food labels. If the type of food has at least three grams of fibre per one hundred grams then they can be labelled as sources of fibre. If the type of food has six or more grams of fibre per one hundred grams then they can be labelled as high in fibre. You should diversify your selection of fibre rich foods. Get a good mix of soluble and insoluble fibre in your diet.


    What is constipation?

    Constipation is defined as having a bowel movement fewer than three times per week. With constipation stools are usually hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel.

    Some people think they are constipated if they do not have a bowel movement every day. However, normal stool elimination may be three times a day or three times a week, depending on the person.

    Constipation is a symptom, not a disease. Almost everyone experiences constipation at some point in their life, and a poor diet typically is the cause. Most constipation is temporary and not serious. Understanding its causes, prevention, and treatment will help most people find relief.

    Who gets constipated?

    Constipation is one of the most common gastrointestinal complaints in the Western world. Those reporting constipation most often are women and adults ages 65 and older.

    Pregnant women may have constipation, and it is a common problem following childbirth or surgery.

    Self-treatment of constipation with over�the�counter (OTC) laxatives is by far the most common aid.

    What causes constipation?

    To understand constipation, it helps to know how the colon, or large intestine, works. As food moves through the colon, the colon absorbs water from the food while it forms waste products, or stool. Muscle contractions in the colon then push the stool toward the rectum. By the time stool reaches the rectum it is solid, because most of the water has been absorbed.

    Constipation occurs when the colon absorbs too much water or if the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. As a result, stools can become hard and dry. Common causes of constipation are

    • not enough fiber in the diet
    • lack of physical activity (especially in the elderly)
    • medications
    • milk
    • irritable bowel syndrome
    • changes in life or routine such as pregnancy, aging, and travel
    • abuse of laxatives
    • ignoring the urge to have a bowel movement
    • dehydration
    • specific diseases or conditions, such as stroke (most common)
    • problems with the colon and rectum
    • problems with intestinal function (chronic idiopathic constipation)
    Not Enough Fiber in the Diet

    People who eat a high-fiber diet are less likely to become constipated. The most common causes of constipation are a diet low in fiber or a diet high in fats, such as cheese, eggs, and meats.

    Fiber�both soluble and insoluble�is the part of fruits, vegetables, and grains that the body cannot digest. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber passes through the intestines almost unchanged. The bulk and soft texture of fiber help prevent hard, dry stools that are difficult to pass.

    Americans eat an average of 5 to 14 grams of fiber daily, which is short of the 20 to 35 grams recommended by the American Dietetic Association. Both children and adults often eat too many refined and processed foods from which the natural fiber has been removed.

    A low-fiber diet also plays a key role in constipation among older adults, who may lose interest in eating and choose foods that are quick to make or buy, such as fast foods, or prepared foods, both of which are usually low in fiber. Also, difficulties with chewing or swallowing may cause older people to eat soft foods that are processed and low in fiber.

    Not Enough Liquids

    Research shows that although increased fluid intake does not necessarily help relieve constipation, many people report some relief from their constipation if they drink fluids such as water and juice and avoid dehydration. Liquids add fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should try to drink liquids every day. However, liquids that contain caffeine, such as coffee and cola drinks, will worsen one's symptoms by causing dehydration. Alcohol is another beverage that causes dehydration. It is important to drink fluids that hydrate the body, especially when consuming caffeine containing drinks or alcoholic beverages.

    Lack of Physical Activity

    A lack of physical activity can lead to constipation, although doctors do not know precisely why. For example, constipation often occurs after an accident or during an illness when one must stay in bed and cannot exercise. Lack of physical activity is thought to be one of the reasons constipation is common in older people.


    Some medications can cause constipation, including

    • pain medications (especially narcotics)
    • antacids that contain aluminum and calcium
    • blood pressure medications (calcium channel blockers)
    • antiparkinson drugs
    • antispasmodics
    • antidepressants
    • iron supplements
    • diuretics
    • anticonvulsants
    Changes in Life or Routine

    During pregnancy, women may be constipated because of hormonal changes or because the uterus compresses the intestine. Aging may also affect bowel regularity, because a slower metabolism results in less intestinal activity and muscle tone. In addition, people often become constipated when travelling, because their normal diet and daily routine are disrupted.

    Abuse of Laxatives

    The common belief that people must have a daily bowel movement has led to self-medicating with OTC laxative products. Although people may feel relief when they use laxatives, typically they must increase the dose over time because the body grows reliant on laxatives in order to have a bowel movement. As a result, laxatives may become habit-forming.

    Ignoring the Urge to Have a Bowel Movement

    People who ignore the urge to have a bowel movement may eventually stop feeling the need to have one, which can lead to constipation. Some people delay having a bowel movement because they do not want to use toilets outside the home. Others ignore the urge because of emotional stress or because they are too busy. Children may postpone having a bowel movement because of stressful toilet training or because they do not want to interrupt their play.

    Specific Diseases

    Diseases that cause constipation include neurological disorders, metabolic and endocrine disorders, and systemic conditions that affect organ systems. These disorders can slow the movement of stool through the colon, rectum, or anus.

    Conditions that can cause constipation are found below.

    • Neurological disorders
      • multiple sclerosis
      • Parkinson's disease
      • chronic idiopathic intestinal pseudo-obstruction
      • stroke
      • spinal cord injuries

    • Metabolic and endocrine conditions
      • diabetes
      • uraemia
      • hypercalcemia
      • poor glycaemic control
      • hypothyroidism

    • Systemic disorders
      • amyloidosis
      • lupus
      • scleroderma
    Problems with the Colon and Rectum

    Intestinal obstruction, scar tissue (adhesions), diverticulosis, tumours, colorectal stricture, Hirschsprung's disease, or cancer can compress, squeeze, or narrow the intestine and rectum and cause constipation.

    Problems with Intestinal Function

    The two types of constipation are idiopathic constipation and functional constipation. Irritable bowel syndrome (IBS) with predominant symptoms of constipation is categorized separately.

    Idiopathic (of unknown origin) constipation does not respond to standard treatment. Idiopathic constipation may be related to problems with intestinal function, including hormonal control, nerve, and muscle problems in the colon, rectum, or anus.

    Functional constipation means that the bowel is healthy but not working properly. It is not caused by organic (occurring naturally in the body) disease. Functional constipation is often the result of poor dietary habits and lifestyle. It occurs in both children and adults and is most common in women. Colonic inertia, delayed transit, and pelvic floor dysfunction are three types of functional constipation. Colonic inertia and delayed transit are caused by a decrease in muscle activity in the colon. These syndromes may affect the entire colon or may be confined to the lower, or sigmoid, colon.

    Pelvic floor dysfunction is caused by a weakness of the muscles in the pelvis surrounding the anus and rectum. However, because this group of muscles is voluntarily controlled to some extent, biofeedback training is somewhat successful in retraining the muscles to function normally and improving the ability to have a bowel movement.

    Functional constipation that stems from problems in the structure of the anus and rectum is known as anorectal dysfunction, or anismus. These abnormalities result in an inability to relax the rectal and anal muscles that allow stool to exit.

    People with IBS having predominantly constipation also have pain and bloating as part of their symptoms.

    How is the cause of constipation identified?

    The tests the doctor performs depend on the duration and severity of the constipation, the person's age, and whether blood in stools, recent changes in bowel habits, or weight loss have occurred. Most people with constipation do not need extensive testing and can be treated with changes in diet and exercise. For example, in young people with mild symptoms, a medical history and physical exam may be all that is needed for diagnosis and treatment.

    Medical History

    The doctor may ask a patient to describe his or her constipation, including duration of symptoms, frequency of bowel movements, consistency of stools, presence of blood in the stool, and toilet habits (how often and where one has bowel movements). A record of eating habits, medication, and level of physical activity will also help the doctor determine the cause of constipation.

    The clinical definition of constipation is having any two of the following symptoms for at least 12 weeks (not necessarily consecutive) in the previous 12 months:

    • straining during bowel movements
    • lumpy or hard stool
    • sensation of incomplete evacuation
    • sensation of anorectal blockage/obstruction
    • fewer than three bowel movements per week
    Physical Examination

    A physical exam may include a rectal exam with a gloved, lubricated finger to evaluate the tone of the muscle that closes off the anus (anal sphincter) and to detect tenderness, obstruction, or blood. In some cases, blood and thyroid tests may be necessary to look for thyroid disease and serum calcium or to rule out inflammatory, metabolic, and other disorders.

    Extensive testing usually is reserved for people with severe symptoms, for those with sudden changes in the number and consistency of bowel movements or blood in the stool, and older adults. Additional tests that may be used to evaluate constipation include

    • a colorectal transit study
    • anorectal function tests
    • a defecography

    Because of an increased risk of colorectal cancer in older adults, the doctor may use tests to rule out a diagnosis of cancer, including a

    • barium enema x ray
    • sigmoidoscopy or colonoscopy

    Colorectal transit study. This test shows how well food moves through the colon. The patient swallows capsules containing small markers that are visible on an x ray. The movement of the markers through the colon is monitored by abdominal x rays taken several times 3 to 7 days after the capsule is swallowed. The patient eats a high-fiber diet during the course of this test.

    Anorectal function tests. These tests diagnose constipation caused by abnormal functioning of the anus or rectum (anorectal function).

    • Anorectal manometry evaluates anal sphincter muscle function. For this test, a catheter or air-filled balloon is inserted into the anus and slowly pulled back through the sphincter muscle to measure muscle tone and contractions.

    • Balloon expulsion tests consist of filling a balloon with varying amounts of water after it has been rectally inserted. Then the patient is asked to expel the balloon. The inability to expel a balloon filled with less than 150 mL of water may indicate a decrease in bowel function.

    Defecography is an x ray of the anorectal area that evaluates completeness of stool elimination, identifies anorectal abnormalities, and evaluates rectal muscle contractions and relaxation. During the exam, the doctor fills the rectum with a soft paste that is the same consistency as stool. The patient sits on a toilet positioned inside an x-ray machine, then relaxes and squeezes the anus to expel the paste. The doctor studies the x rays for anorectal problems that occurred as the paste was expelled.

    Barium enema x ray. This exam involves viewing the rectum, colon, and lower part of the small intestine to locate problems. This part of the digestive tract is known as the bowel. This test may show intestinal obstruction and Hirschsprung's disease, which is a lack of nerves within the colon.

    The night before the test, bowel cleansing, also called bowel prep, is necessary to clear the lower digestive tract. The patient drinks a special liquid to flush out the bowel. A clean bowel is important, because even a small amount of stool in the colon can hide details and result in an incomplete exam.

    Because the colon does not show up well on x rays, the doctor fills it with barium, a chalky liquid that makes the area visible. Once the mixture coats the inside of the colon and rectum, x rays are taken that show their shape and condition. The patient may feel some abdominal cramping when the barium fills the colon but usually feels little discomfort after the procedure. Stools may be white in colour for a few days after the exam.

    Sigmoidoscopy or colonoscopy. An examination of the rectum and lower, or sigmoid, colon is called a sigmoidoscopy. An examination of the rectum and entire colon is called a colonoscopy.

    The person usually has a liquid dinner the night before a colonoscopy or sigmoidoscopy and takes an enema early the next morning. An enema an hour before the test may also be necessary.

    To perform a sigmoidoscopy, the doctor uses a long, flexible tube with a light on the end, called a sigmoidoscope, to view the rectum and lower colon. The patient is lightly sedated before the exam. First, the doctor examines the rectum with a gloved, lubricated finger. Then, the sigmoidoscope is inserted through the anus into the rectum and lower colon. The procedure may cause abdominal pressure and a mild sensation of wanting to move the bowels. The doctor may fill the colon with air to get a better view. The air can cause mild cramping.

    To perform a colonoscopy, the doctor uses a flexible tube with a light on the end, called a colonoscope, to view the entire colon. This tube is longer than a sigmoidoscope. During the exam, the patient lies on his or her side, and the doctor inserts the tube through the anus and rectum into the colon. If an abnormality is seen, the doctor can use the colonoscope to remove a small piece of tissue for examination (biopsy). The patient may feel gassy and bloated after the procedure.

    How is constipation treated?

    Although treatment depends on the cause, severity, and duration of the constipation, in most cases dietary and lifestyle changes will help relieve symptoms and help prevent them from recurring.


    A diet with enough fiber (20 to 35 grams each day) helps the body form soft, bulky stool. A doctor or dietitian can help plan an appropriate diet. High-fiber foods include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, Brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important.

    Lifestyle Changes

    Other changes that may help treat and prevent constipation include drinking enough water and other liquids, such as fruit and vegetable juices and clear soups, so as not to become dehydrated, engaging in daily exercise, and reserving enough time to have a bowel movement. In addition, the urge to have a bowel movement should not be ignored.


    Most people who are mildly constipated do not need laxatives. However, for those who have made diet and lifestyle changes and are still constipated, a doctor may recommend laxatives or enemas for a limited time. These treatments can help retrain a chronically sluggish bowel. For children, short-term treatment with laxatives, along with retraining to establish regular bowel habits, helps prevent constipation.

    A doctor should determine when a patient needs a laxative and which form is best. Laxatives taken by mouth are available in liquid, tablet, gum powder, and granule forms. They work in various ways:

    • Bulk-forming laxatives generally are considered the safest, but they can interfere with absorption of some medicines. These laxatives, also known as fiber supplements, are taken with water. They absorb water in the intestine and make the stool softer. Brand names include Metamucil, Fiberall, Citrucel, Konsyl, and Serutan. These agents must be taken with water or they can cause obstruction. Many people also report no relief after taking bulking agents and suffer from a worsening in bloating and abdominal pain.

    • Stimulants cause rhythmic muscle contractions in the intestines. Brand names include Correctol, Dulcolax, Purge, and Senokot. Studies suggest that phenolphthalein, an ingredient in some stimulant laxatives, might increase a person's risk for cancer. The Food and Drug Administration has proposed a ban on all over-the-counter products containing phenolphthalein. Most laxative makers have replaced, or plan to replace, phenolphthalein with a safer ingredient.

    • Osmotics cause fluids to flow in a special way through the colon, resulting in bowel distention. This class of drugs is useful for people with idiopathic constipation. Brand names include Cephulac, Sorbitol, and Miralax. People with diabetes should be monitored for electrolyte imbalances.

    • Stool softeners moisten the stool and prevent dehydration. These laxatives are often recommended after childbirth or surgery. Brand names include Colace and Surfak. These products are suggested for people who should avoid straining in order to pass a bowel movement. The prolonged use of this class of drugs may result in an electrolyte imbalance.

    • Lubricants grease the stool, enabling it to move through the intestine more easily. Mineral oil is the most common example. Brand names include Fleet and Zymenol. Lubricants typically stimulate a bowel movement within 8 hours.

    • Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Brand names include Milk of Magnesia and Haley's M-O. Saline laxatives are used to treat acute constipation if there is no indication of bowel obstruction. Electrolyte imbalances have been reported with extended use, especially in small children and people with renal deficiency.

    • Chloride channel activators increase intestinal fluid and motility to help stool pass, thereby reducing the symptoms of constipation. One such agent is Amitiza, which has been shown to be safely used for up to 6 to 12 months. Thereafter a doctor should assess the need for continued use.

    • Serotonin agonists help the muscles in your intestines work correctly when a slow-moving digestive system is caused by low levels of serotonin. Serotonin is a neurotransmitter found mostly in the digestive tract. One brand-name agent is Zelnorm, which is prescribed for the short-term treatment of chronic constipation in people less than 65 years of age.

    People who are dependent on laxatives need to slowly stop using them. A doctor can assist in this process. For most people, stopping laxatives restores the colon's natural ability to contract.

    Other Treatments

    Treatment for constipation may be directed at a specific cause. For example, the doctor may recommend discontinuing medication or performing surgery to correct an anorectal problem such as rectal prolapse, a condition in which the lower portion of the colon turns inside out.

    People with chronic constipation caused by anorectal dysfunction can use biofeedback to retrain the muscles that control bowel movements. Biofeedback involves using a sensor to monitor muscle activity, which is displayed on a computer screen, allowing for an accurate assessment of body functions. A health care professional uses this information to help the patient learn how to retrain these muscles.

    Surgical removal of the colon may be an option for people with severe symptoms caused by colonic inertia. However, the benefits of this surgery must be weighed against possible complications, which include abdominal pain and diarrhoea.

    Can constipation be serious?

    Sometimes constipation can lead to complications. These complications include haemorrhoids, caused by straining to have a bowel movement, or anal fissures (tears in the skin around the anus) caused when hard stool stretches the sphincter muscle. As a result, rectal bleeding may occur, appearing as bright red streaks on the surface of the stool. Treatment for haemorrhoids may include warm tub baths, ice packs, and application of a special cream to the affected area. Treatment for anal fissures may include stretching the sphincter muscle or surgically removing the tissue or skin in the affected area.

    Sometimes straining causes a small amount of intestinal lining to push out from the anal opening. This condition, known as rectal prolapse, may lead to secretion of mucus from the anus. Usually eliminating the cause of the prolapse, such as straining or coughing, is the only treatment necessary. Severe or chronic prolapse requires surgery to strengthen and tighten the anal sphincter muscle or to repair the prolapsed lining.

    Constipation may also cause hard stool to pack the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. This condition, called faecal impaction, occurs most often in children and older adults. An impaction can be softened with mineral oil taken by mouth and by an enema. After softening the impaction, the doctor may break up and remove part of the hardened stool by inserting one or two fingers into the anus.
    Powered by WebRing.