How food poi­son­ing ru­ined my gut (and my life) for YEARS

Daily Mail - - Good Health - By JINAN HARB

An at­tack of food poi­son­ing can be pretty grim, and more than half a mil­lion of us have to deal with it ev­ery year. that’s the of­fi­cial fig­ure — the true num­ber is prob­a­bly even higher, as many won’t bother their GP about it.

But while most peo­ple will re­cover af­ter days, or even a few weeks, some can suf­fer for months, or be left with other health prob­lems — some­times life­long, in­clud­ing ir­ri­ta­ble bowel syn­drome, lac­tose in­tol­er­ance, arthri­tis, high blood pres­sure and even kid­ney fail­ure.

now, re­search has shown that cer­tain strains of Sal­mo­nella bac­te­ria, a ma­jor cul­prit in food poi­son­ing, may per­ma­nently damage the Dna in our cells. a study by cor­nell Univer­sity in the U.S., look­ing at hu­man cells in a lab which were in­fected with four types of Sal­mo­nella, found all had per­ma­nent Dna damage. the au­thors likened the ef­fect to that of sun­burned skin which is then left vul­ner­a­ble to skin can­cer.

the longer- term im­pact of food poi­son­ing was first iden­ti­fied many years ago, says Peter Whor­well, a pro­fes­sor of gas­troen­terol­ogy at the Univer­sity of Manch­ester. ‘But it’s been pretty much ig­nored, and is grossly un­der­es­ti­mated,’ he adds.

the prob­lem, he says, is no one makes the con­nec­tion, and typ­i­cal symp­toms can then worsen into chronic dis­eases.

‘When doc­tors see a pa­tient’s symp­toms they don’t tend to take a proper his­tory of where symp­toms started or try to pin down the orig­i­nal trig­ger — which, in my ex­pe­ri­ence, may well be gas­troen­teri­tis [gut prob­lems as a re­sult of food poi­son­ing]. a tummy up­set doesn’t even need to be par­tic­u­larly bad to have last­ing ef­fects.’

Pro­fes­sor Qasim aziz, a pro­fes­sor of neu­ro­gas­troen­terol­ogy at Queen Mary, Univer­sity of London, adds: ‘When th­ese com­pli­ca­tions oc­cur the orig­i­nal in­fec­tion has cleared and there’s no ev­i­dence of that in­fec­tion left so not ev­ery­one makes the link.’

SOME­ONE who knows the long-term ef­fect of food poi­son­ing is nancy Fahmy, from Har­row, Mid­dle­sex. ten years on from an in­fec­tion af­ter a meal to cel­e­brate her 28th birth­day, she is still liv­ing with life-chang­ing reper­cus­sions.

‘I went home af­ter my night out with friends, and woke at 2am. I had stom­ach cramps, was drip­ping with sweat and I was sick,’ she re­calls, de­scrib­ing typ­i­cal food poi­son­ing symp­toms.

‘My boyfriend at the time took me to a&e, where they said I had food poi­son­ing and sent me home with anti-sick­ness tablets and told me to drink plenty of flu­ids. But from that day, I’ve never felt well.’

Months passed and nancy was still re­peat­edly sick and hav­ing con­stant ab­dom­i­nal pain. Her GP di­ag­nosed ir­ri­ta­ble bowel syn­drome, say­ing it might pass.

But over the next few months her con­di­tion wors­ened. ‘ Some evenings I would be sick mul­ti­ple times and couldn’t keep any­thing down. the weight kept drop­ping off,’ says nancy, a DJ who is also a qual­i­fied chef. ‘at one point I was los­ing 1-1.5kg (2½ -3 lb) a week, and while that slowed down, over a year I dropped 16kg.’ By March 2011 she weighed 34kg, less than 5½st (she’s 5ft 7in).

It took four years of hospi­tal re­fer­rals and ap­point­ments with all kinds of spe­cial­ists — in­clud­ing gas­troen­terol­o­gists, neu­rol­o­gists and psy­chother­a­pists — be­fore the cause was finally iden­ti­fied: the food poi­son­ing had es­sen­tially stopped nancy’s stom­ach and in­testines work­ing, and they were not push­ing food along.

the damage caused by food poi­son­ing de­pends on what bug causes the in­fec­tion. For ex­am­ple, stud­ies have linked in­fec­tion with e.coli (of­ten due to poor hy­giene) to kid­ney fail­ure, says Pro­fes­sor Whor­well.

‘Part of the prob­lem is that with se­vere gas­troen­teri­tis that causes vomit­ing and di­ar­rhoea, a lot of fluid is lost and peo­ple be­come de­hy­drated — if you are de­hy­drated for long enough then the kid­neys will fail,’ he says.

Mean­while, Sal­mo­nella poi­son­ing (typ­i­cally caused by in­fected meat, poul­try and eggs) has been blamed for a form of arthri­tis; and campy­lobac­ter bac­te­ria (passed on in in­fected raw poul­try and fresh pro­duce) has been linked to bowel func­tion prob­lems such as ir­ri­ta­ble bowel syn­drome.

In other cases, damage to the lin­ing of the gut causes the longert­erm com­pli­ca­tions.

For ex­am­ple, a se­vere case of gas­troen­teri­tis can strip off cells in the gut lin­ing that make en­zymes that break down lac­tose (the sugar in milk), so the pa­tient can no longer di­gest it, caus­ing bloat­ing, di­ar­rhoea and stom­ach cramps.

‘thank­fully, the lin­ing of the gut, known as the brush border, heals it­self, and so this lac­tose in­tol­er­ance usu­ally only lasts a few weeks,’ says Pro­fes­sor Whor­well.

But for pa­tients like nancy, there’s not al­ways a clear- cut ex­pla­na­tion. one the­ory is that a pro­longed in­fec­tion causes ex­ces­sive damage to the gut, and the con­stant low-grade in­flam­ma­tion in the body is what causes the last­ing com­pli­ca­tions.

‘a cer­tain de­gree of in­flam­ma­tion is part of the nor­mal im­mune re­sponse to food poi­son­ing,’ ex­plains charles Mur­ray, a con­sul­tant gas­troen­terol­o­gist at the royal Free London NHS Foun­da­tion trust.

‘Most cases will set­tle down, but in a small mi­nor­ity, in­flam­ma­tion can lead to prob­lems with food mov­ing through the gut, an al­ter­ation of bowel habits and se­vere pain.’

an­other sug­ges­tion is that pro­longed low-grade in­flam­ma­tion makes the gut ‘ leaky’, so too many food par­ti­cles get through the gut wall. this trig­gers an im­mune re­sponse which drives fur­ther in­flam­ma­tion and an at­tack on healthy cells in the in­tes­tine.

over time, there’s just too much damage to healthy tis­sue than the im­mune sys­tem can re­pair.

What is known is that in­flam­ma­tion can damage the mus­cles and/ or nerves that sup­ply the gut wall, and if it does, it can stop that part of the gut func­tion­ing per­ma­nently — it doesn’t then con­tract prop­erly, so food isn’t moved along cor­rectly. ‘Pa­tients are given medicines — such as painkillers — and nu­tri­tional sup­port [such as a feed­ing tube], but in th­ese rare cases, gut func­tion can­not be re­stored,’ says Dr Mur­ray. Some pa­tients may be more vul­ner­a­ble, he adds. Dis­eases that af­fect gut mus­cles, such as sclero­derma (where the im­mune sys­tem at­tacks healthy con­nec­tive tis­sue around the body), or a fam­ily his­tory of gut prob­lems, can make th­ese pa­tients more prone to ‘ex­ces­sive, longterm re­ac­tions’ to seem­ingly harm­less food poi­son­ing, for ex­am­ple. nancy’s food poi­son­ing trig­gered an ill­ness ly­ing dor­mant in her body, known as chronic id­io­pathic in­testi­nal pseudo- ob­struc­tion, where the gut stops mov­ing food. But there were no signs to sug­gest her life would change af­ter her birth­day meal on oc­to­ber 5, 2007. ‘I used to run and play hockey, and went to the gym three or four times a week right up un­til the day be­fore my food poi­son­ing,’ she says. ‘now I can’t run or swim as I get out of breath quickly. If I have an event to go to, I make sure I have a week off in ad­vance to build up my en­ergy.’ nancy was finally told what was wrong with her in May 2011 when she was re­ferred to St Mark’s Hospi­tal in London, which has a spe­cial­ist bowel clinic. as well as chronic id­io­pathic in­testi­nal pseudo-ob­struc­tion, she has gas­tro­pare­sis, where the stom­ach can­not empty it­self prop­erly. and as a re­sult of her rapid weight loss, nancy’s other or­gans weak­ened and never re­cov­ered. She has de­vel­oped arthri­tis in her spine and hands; os­teo­poro­sis in her neck, spine and hip; pos­tural tachy­car­dia syn­drome, where her heart beats ab­nor­mally fast if she stands up quickly, and is un­able to empty her blad­der prop­erly. ‘I’m on a whole load of in­jec­tions and patches, but I am al­ways aching and in pain and still throw up about 20 times a day,’ says nancy. She has to have nu­tri­ents pumped di­rectly into veins in her chest each evening as she can’t di­gest any food or drink. ‘I would have thought that, at 37, I’d be mar­ried with kids and have a suc­cess­ful ca­reer,’ she says. ‘Sadly it’s noth­ing like I’d imag­ined things to be — and cer­tainly not from a bout of food poi­son­ing.’

Pic­ture: RAIN CHANDRIC

Years of suf­fer­ing: Nancy Fahmy

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