Ileocecal Valve Syndrome: Diet and Management

The ileocecal valve (ICV) plays a critical role in the digestive system. Dysfunction of this valve can lead to a variety of symptoms and health issues. This article explores the ileocecal valve syndrome, its causes, symptoms, and dietary and lifestyle management strategies.

Understanding the Digestive Process

Digestion is a multi-stage process where food and liquids are broken down into chyme, a semi-fluid mass. This process begins in the mouth with chewing, which mixes food with saliva, initiating the breakdown of proteins and raising stomach acid levels. The food then moves into the stomach, where it is further digested by stomach acids and enzymes.

The small intestine, often referred to as the "kitchen" of the bowel, is where the majority of nutrient and fluid absorption occurs. Chyme moves through the small intestine via peristalsis, allowing for this absorption. The small intestine consists of the Duodenum, Jejenum and Ileum. The Duodenum collects chyme from the stomach, digestive enzymes from the pancreas, and bile from the liver. The Jejenum churns the food with the digestive juices. The food spends the longest time in the Ileum, which is responsible for completing nutrient and vitamin absorption.

After the small intestine processes and absorbs nutrients, the remaining waste moves into the large intestine (colon) for expulsion from the body.

The Ileocecal Valve: Gatekeeper Between Intestines

The ileocecal valve (ICV) is a sphincter located between the ileum (the last part of the small intestine) and the cecum (the first part of the large intestine). Positioned in the lower right quadrant of the abdomen, near the appendix, the ICV's primary function is to allow the passage of digested food material from the small intestine into the large intestine. The function of the ICV is simple. It opens to allow waste material from the small intestine to pass into the large intestine. The large intestine absorbs water and salts back into the body, leaving the remaining faecal matter to be eliminated through bowel movements.

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The ICV also prevents waste products and bacteria from flowing back into the small intestine, ensuring one-way movement.

Ileocecal Valve Dysfunction or Syndrome

Ileocecal Valve (ICV) Dysfunction or Syndrome occurs when the ICV becomes stuck in an open or closed position, disrupting the normal digestive process. In normal circumstances, the ICV remains closed most of the time, opening briefly to allow the contents of the small intestine to move into the large intestine, then closing again quickly to prevent backflow. Problems occur if the valve stays open too long or not long enough.

Open Valve

When the ICV is stuck in an open position, chyme may move through the gut too rapidly, leading to diarrhea and compromising nutrient and fluid absorption in the small intestine. Additionally, waste products and bacteria from the large intestine can back up into the small intestine, leading to:

• Irritation of the intestinal lining
• Increased risk of systemic toxicity and inflammation
• Overburdening of the liver
• Reduced immunity
• Development or onset of degenerative or autoimmune conditions
• Severe gas and bloating due to bacterial overgrowth in the small intestine

Closed Valve

Conversely, when the ICV is stuck in a closed position, feces cannot efficiently move past the small intestine, resulting in constipation. The slow transit time can cause the small intestine to continue absorbing waste products and toxins before they reach the large intestine, again leading to:

• Irritation of the intestinal lining
• Increased risk of systemic toxicity and inflammation
• Overburdening of the liver
• Reduced immunity
• Development or onset of degenerative or autoimmune conditions
• Constipation
• Bloating in the upper and lower abdomen
• Acid reflux (heartburn)

ICV dysfunction is found frequently in the general population- possibly up to 90% of people and often goes undiagnosed.

Read also: Weight Loss Following Valve Replacement

Causes of Ileocecal Valve Problems

Several factors can contribute to ICV dysfunction:

• Digestion: Overeating, eating too frequently or quickly, under-chewing food, and insufficient stomach acid (hypochlorhydria) or digestive enzymes.
• Diet: Excessive spicy or roughage-type foods, food sensitivities, excessive cooked food, not enough raw food, a high carbohydrate/low protein diet, inadequate fiber intake, and a diet high in processed foods, inflammatory grains, and refined sugars.
• Chronic dehydration: Dehydration is a precursor to a stuck ileocecal valve. Make sure you drink plenty of water.
• Stress or emotional trauma: The gut-brain axis (GBA) highlights the connection between thoughts and gut health.
• Appendicectomy: Removal of the appendix may affect ICV function.
• Prolonged courses of antibiotics or other drugs: Can lead to dysbiosis (imbalance of the gut microbiome).
• Imbalances or deficiencies of digestive enzymes or nutrients.
• Constitutional or familial factors.
• Physical weakness: Too little or too much exercise disturbing the digestive system.
• Energy drains: Phones, too much screen time, electromagnetic pollution, overwork.
• Postural misalignment: Especially from hip issues, jaw problems and upper thigh muscle wastage.
• SIBO (Small Intestine Bacterial Overgrowth).

The Bowel Hormone Storm

Hormonal imbalances can also play a role in ICV dysfunction:

• Imbalanced blood sugars: Eating a diet high in carbohydrates, inflammatory grains, or highly processed foods can disrupt blood sugar levels.
• Digestive hormone imbalances: Imbalanced blood sugars can affect digestive hormones like motilin, adrenaline, and cortisol.
• Muscle tension and misalignment: Stress can cause muscle tension, leading to pelvic misalignment and ICV dysfunction.
• Impact on sex hormones: High insulin and cortisol levels can reduce sex hormones like progesterone, impacting fertility.
• Serotonin level changes: Serotonin, mostly produced in the gut, affects the gut, brain, and mental/emotional health.
• Elevated histamine levels: High estrogen and gut disturbances contribute to increased inflammation and immune response.
• Gut-brain crosstalk: Gut hormones like ghrelin, PYY, GLP-1, GIP, and CCK modulate the central nervous system and metabolic control.

Symptoms of Ileocecal Valve Syndrome

ICV dysfunction can manifest in a wide range of symptoms, often making it difficult to diagnose. It is sometimes called “the great mimicker” due to the wide range of symptoms that can manifest as a result of its dysfunction. Symptoms can include:

• Digestion: Chronic diarrhea or loose stools, chronic constipation, abdominal pain, gas, borborygmus (gurgling), right-sided groin pain, bloating, distended belly, burping or belching, indigestion, general non-specific lower GI discomfort, right-sided lower abdominal pain (ICV), left-sided lower abdominal pain (the valves of Houston).
• Digestive Disorders: Inflammatory Bowel Disease (IBD) (i.e. Ulcerative Colitis or Crohn’s Disease); Irritable Bowel Syndrome (IBS); Diverticulitis; Spastic Colon; Celiac Disease; Small Intestinal Bacterial Overgrowth (SIBO).
• Headache or Migraine; sharp, pinpoint headaches (especially on the left side at the base of the skull); dull frontal headaches
• Joint pain; arthritis; shoulder or neck pain; frozen shoulder; bursitis-like pain in the shoulders and hip joints; right-sided hip or groin pain; carpal tunnel syndrome; right-sided shoulder pain at night.
• Lower back pain: Ideopathic lower back (pain for no reason); sudden, stabbing or sharp lower back pain; pseudo-sacroiliac strain.
• Leg pain-particularly right-sided; burning leg pain (that feels like a nerve) radiating into the front of the left thigh.
• Nerve Impingement.
• Muscular aches and pains.
• Chest pain; palpitations; pain around the heart.
• Dizziness; lightheadedness; faintness; vertigo; blurred vision.
• Flu symptoms; feverishness.
• Chronic fatigue; post-viral fatigue; general lethargy.
• Pseudo-hypochlorhydria (deficiency of stomach acid).
• Sudden or chronic thirst.
• Nausea.
• Tinnitus (ringing in the ears); fullness/pressure in the ears.
• Recurrent or chronic sinus infections; sinusitis.
• Post nasal drip.
• Allergies; asthma-like symptoms; food or environmental sensitivities; hay fever.
• Bad breath; body odour.
• Depression; low mood; anxiety.
• Skin conditions: eczema; psoriasis; acne, pallor (pale complexion); dark circles under the eyes; hives (urticaria); puffy cheeks.
• Women’s health and fertility: painful periods (dysmenorrhoea), endometriosis, Polycystic Ovary Syndrome (PCOS).
• Oedema: fluid retention or swelling.
• Candida or fungal overgrowth.
• Symptoms that improve after getting out of bed and moving around.
• Symptoms that intensify while lying down or at night.

Treatment and Management Strategies

Treating ICV dysfunction requires a holistic approach, including physical manipulation, dietary changes, and lifestyle adjustments.

Physical Manipulation of the Valve

Physical manipulation or massage can correct improper nerve control in the short term, as the ICV functions under the control of the vagus nerve.

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• For an Open Valve: One can massage or hold the valve shut by adhering to the following steps:
  • Place both thumbs over the ICV.
  • Making sure to keep your thumbs flat, press straight down into the abdomen towards the back.
  • While continuing to press deeply, push upwards towards the left shoulder for 20-30 seconds-bearing in mind that this can be particularly uncomfortable. Pain may be localised or refer superiorly into the chest or stomach area, posteriorly into the back or distally into the groin or down the right leg. If you feel acute pain when pressing on this spot, it is likely to be an open ICV problem, which can feel more or less tender depending on the individual and the severity of ICV dysfunction. Locating the tender spot(s) while lying down may be easier.
  • One can place a cold pack over the valve for approximately 15 to 20 minutes. A cold pack can be particularly valuable with a long-standing, difficult-to-treat ICV dysfunction. This should comprise cold tap water, not ice.
  • Both steps above should be repeated as necessary.

Dietary Recommendations

Dietary changes are crucial for managing ICV syndrome.

• Elimination Diet: An elimination diet for SIBO may help you identify foods that bring on your digestive symptoms. However, an elimination diet is not a treatment for SIBO. Traditional treatment methods shouldn’t be ignored. It’s important to work with a registered dietitian with training in SIBO conditions.
• General Guidelines: In general try to eat fresh, whole, organic foods. The body does not tolerate well chemicals in foods such as preservatives, rancid oils (such as vegetable oil), food colorings, pesticides, fungicides and herbicides.
• Foods to Limit or Avoid: Carbonated drinks, alcohol, caffeine, chocolate, raw foods, and hot spicy foods.
• Foods to Avoid for 2-3 Weeks:
  • Roughage foods: popcorn, nuts, potato chips, pretzels, seeds, whole grains
  • Raw fruits and vegetables: celery, bell peppers, cucumbers, cabbage, carrots, lettuce, tomatoes
  • Spicy foods: chili powder, hot peppers, salsas, black and cayenne pepper, paprika, cloves, cinnamon
  • Stimulants: liquors, alcoholic drinks, cocoa, chocolate, caffeine products
• For an Open Valve: Eliminate roughage-type foods for four weeks.
• RightNutrition Meal Plan:
  • Water-drink spring water or a good filtered water. Not reverse osmosis. 1 liter per 50 lbs of body weight per day.
  • Snack-if you’ve been told you have a blood sugar issue, snack with protein/fat every 2-3 hours, and have a snack right before sleep.
  • The diet we have patients follow eliminates all refined sugar and refined carbohydrates which are toxic to the body, depress the immune system and imbalance the biochemistry of the body. It also eliminates foods that most people are sensitive to. This diet among other things will keep your blood sugar in balance which will help to maintain the corrections that we make to your body.
  • Most people are wheat, dairy and soy sensitive, and in 50% of people corn is a problem. Adding these back into your diet could have an even much more adverse effect on your health then even sugars or starch.
• Low-FODMAP Diet:
  • Consider temporarily eliminating FODMAPs, difficult-to-digest carbs fermented by gut bacteria.
  • High-FODMAP foods include: high-fructose corn syrup, agave nectar, honey, soda and soft drinks, garlic, onions, asparagus, butternut squash, cauliflower, artichokes, beans, apples, dried fruits, sausage, flavored yogurt, ice cream, sweetened cereals, barley, rye, grains, peas, mannitol, sorbitol.
  • Some of the acceptable foods for a low-FODMAP diet include: meat, fish, eggs, crackers (gluten-free), oatmeal, unsweetened cereal (made from low FODMAP grains), spaghetti squash and summer squashes, broccoli (heads only, less than 3/4 cup), leafy greens, carrots, rice or gluten-free noodles, olives, peanuts, potatoes, pumpkin, quinoa, seeds, some fruits (blueberries, grapes, oranges, and strawberries).
• Additional Dietary Changes:
  • Eliminate identified food sensitivities.
  • Until the ileocecal value is functioning properly, lettuce, popcorn, raw vegetables and fruits, and foods in the cabbage family are avoided until inflammation, gas, bloating and bowel dysfunction are under control.
  • Avoid red meat as a source of protein, substituting fresh fish, veal, lamb, and skinless poultry until symptoms are gone.
  • Eliminate refined carbohydrate, processed foods, alcohol, fried foods and caffeine as they are harder on the digestive system and help fuel inflammation.
  • Drink at least eight glasses of water a day.
  • You must chew your food as thoroughly as possible. If food is not chewed into a liquid form, large chunks of food are passed through the tube to the ileocecal value, which can cause problems.
• Other considerations:
  • Chlorophyll may help to heal an open ICV. Also, chlorophyll complex perles contain fat-soluble vitamins, including vitamin K, and can be helpful for pain relief.
  • Add lactic acid yeast wafers to one’s diet. These can be sourced at any health food store or online.
  • For a Closed Valve: add calcium (or silicon when calcium can’t be absorbed), magnesium and vitamin D to one’s diet.

Lifestyle Adjustments

• Stress Management: Control Stress Stress is one of the leading causes of inflammation in the body. A high stress level heavily impacts digestive health. Emotional traumas and work related stressors are known to have a direct impact on the ileocecal valve shutting down. It is important to participate in outlets such as exercise, meditation, yoga or massage in order to reduce stress levels.
• Proper Eating Habits: Establishing proper eating habits; for example only eating when sitting down, eating slowly, and fully chewing food before swallowing.

Supplements

During Vital Health’s Food Sensitivities Screening, Dr. Griffin can measure which foods and environmental sensitivities trigger a negative response in the body. By removing sensitive foods from the diet, inflammation in the intestinal wall will be reduced and proper functioning of the ileococal valve restored. During the painless and non-invasive EVA Screening, Dr. Griffin can identify what supplements will further support the body and aide the ileocecal valve in performing its critical role in the digestive system. For example, if digestive inflammation is severe, supplements will be suggested to get the inflammation under control. Digestive enzymes, probiotics, intestinal soothing formulas, calcium and/or magnesium and chlorophyll will typically help in calming the irritated ileocecal valve.

• Digestive Enzyme Supplements
• For Open Valve: Add lactic acid yeast wafers to one’s diet. These can be sourced at any health food store or online.
• For a Closed Valve: add calcium (or silicon when calcium can’t be absorbed), magnesium and vitamin D to one’s diet.

Medical Treatments

• Antibiotics: Antibiotics are the primary treatment for SIBO. These medications get rid of the bacteria that’s overgrowing in the small intestine.
• Elemental Diet: When antibiotics alone do not help, the elemental diet is the only diet proven to treat SIBO. It is a predigested liquid diet prescribed by a doctor.

Research Study on ICV and SIBO

A research study explored whether patients with positive lactulose breath tests (indicative of SIBO) may have an incompetent ICV leading to reflux of colonic contents into the small intestine. The study found that subjects with a positive lactulose breath test have a defective ICV cecal distension reflex compared to normal subjects.

tags: #ileocecal #valve #syndrome #diet