Other dietary components that may induce GI symptoms include capsaisin, caffeine, and various minerals. Capsaisin is the "active" ingredient in hot peppers and reacts with specific receptors in the mucosa that activate enteric sensory nerves. The physiological "purpose" of these receptors is not clear at the present time. Caffeine and other bioactive amines have pharmacological effects when ingested in milligram amounts. In addition to central nervous system effects, the co-editor of this text and his colleagues have shown that caffeine can increase intestinal chloride secretion by inhibiting phosphodiesterase, which may exaggerate diarrhea in patients with ileostomies and in those with IBS (Wald et al, 1976). Minerals such as calcium, aluminum, and iron tend
*Editor's Note: Patients learn to eat grilled chicken breast rather than hamburger at fast food restaurants. (TMB)
to be constipating, whereas magnesium may cause diarrhea. Many patients ingest dietary supplements containing these elements and may not be aware of their effects on bowel fUnction. Finally, many patients ingest "health foods" which often contain herbal products, including senna and aloe, which can have profound effects on gut function. Every patient needs to be asked about ingestion of these products. There is a separate chapter on alternative medicines (Chapter 58, "Complementary and Alternative Medicines in Gastrointestinal Disease").*
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