At the basis of a proper functioning of the intestine there is certainly a healthy and balanced diet, rich in fiber, low in fats of animal origin combined with regular physical activity. Not for everyone, however, this is enough to avoid annoyances and problems that can be diagnosed with different types of tests and analyses more or less invasive, from simple blood tests, to ultrasounds and colonoscopies.

We talked with Dr. Federica Furfaro, gastroenterologist at Humanitas, about how to keep the intestine healthy, clean and regular.


Reading the intestine: first signs

Intestinal disorders, such as excessive gas production, spasms and swelling are often the wake-up call for disorders that can be caused by an irregular diet, an unbalanced diet or an excessive level of stress.

In this case we find, for example, stools that are too soft and smelly or, on the contrary, hard and goat-like; these are some of the most evident signs that our intestines can send us to tell us that they are not healthy.


The FodMap diet and the ‘rest’ of the intestine

The FodMap diet has been developed to improve the symptoms of irritable bowel syndrome, often characterized by swelling, cramping and alteration of intestinal regularity. It was developed by two gastroenterologists and a dietitian from Monash University in Melbourne.

FodMap stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, or oligosaccharides, disaccharides, fermentable monosaccharides and polyols, sugars that can ferment in the intestine thanks to the action of intestinal bacteria. These components are present in many foods – in different qualities of fruit and vegetables, in cheeses and milk products, as well as in cereals – which in case of intestinal disorders is preferable to avoid because they are highly ‘fermentable’ (e.g. artichokes and cauliflower, mushrooms, garlic and onions, apples and pears, milk from cows, goats and sheep).

Among the products for a low-Fodmap with a low content of fermentable molecules, there are instead chickpeas and canned lentils, zucchini, ginger, radish, broccoli, fennel and lettuce, milk and derivatives without lactose, berries, kiwi and grapes.

Since its first publication, more than ten years ago, the effectiveness of the diet has been validated by various scientific researches and has entered into clinical practice.


Supplements and probiotics

To improve the functionality of the intestine, experts propose supplements based on fiber, probiotics and prebiotics. In particular, the fibers improve intestinal emptying; probiotics are living micro-organisms that, administered in adequate quantities, promote an improvement of the intestinal microbial balance through inhibition of pathogenic bacteria; finally, prebiotics are indigestible organic substances, capable of selectively stimulating the growth and/or activity of beneficial bacteria present in the colon.


The ancient practice of hydrocolon therapy

Hydrocolon therapy consists in a real washing of the intestine and aims to improve the functioning of the colon by eliminating toxins and digestion residues left between the walls and loops of the intestine.

It has been a widespread practice since ancient times and is often proposed as a remedy to eliminate intestinal disorders and constipation problems. “It dates back to the time of the ancient Egyptians when it was thought that purifying the body of waste could prevent any disease – explained Dr. Furfaro, gastroenterologist at the Humanitas hospital. The Egyptians first, but also the ancient Greeks and Romans used the enemas for over 20 different gastric and intestinal symptoms.

“To date, there is no scientific evidence to support the prescription, but this intestinal washing finds indications as an adjunct in the preparation for colonoscopy and in some specific conditions such as stubborn constipation, spinal cord injury, in cases of alteration of the bacterial flora, and skin allergies. There is, however, no scientific data to suggest the use of hydrocolon therapy in healthy subjects,” concluded the specialist.

According to a 2011 study by Georgetown University, it may also present some contraindications: “Side effects may be the development of an electrolyte alteration, following excessive diarrhea, or a perforation caused by the placement of the tube within the colon. Contraindications are mainly acute bowel disease, such as diverticulitis, or chronic inflammatory bowel disease. Hydrocholon therapy – finally explained Dr. Furfaro – is also not recommended in immunosuppressed patients”.

For this reason “I recommend hydrocolon therapy only in selected cases, particularly in patients with stubborn constipation problems not responding to medical therapy – said Furfaro. I do not believe, however, that this technique is a solution to the problem; it can rather be used as a palliative procedure to improve the quality of life of the patient, but has a limited effect in time. However, it is not advisable to perform this procedure very often because of the risk of developing hydroelectrolytic imbalances”.

Medical centers often propose this treatment in packages of sessions, but for the doctor “it is necessary to carefully evaluate the type of procedure proposed and the interval between the various administrations, in order to avoid possible complications”.


The opinion of Humanitas

“In fact, there is no accredited method of “intestinal purification”, the same for all patients, and it is not necessary to plan an “intestinal purification” if the function is regular – explained Furfaro. Patients with stubborn constipation should use laxatives to “cleanse” the intestine, before assessing the use of invasive techniques such as hydrocolon therapy. In subjects with alteration of the microbiota or bacterial overgrowth it is advisable to use selective antibiotic therapies for the intestine and then the use of probiotics, to restore the correct intestinal bacterial flora, thus “cleaning” the body from “pathogenic” bacteria.