Managing Digestive Disorders
We know that bad food can cause an upset stomach but the way in which diet can trigger or affect a chronic digestive disorder has not yet been fully explained. However, it is quite clear that certain disorders are profoundly influenced by what we do or do not eat or can be helped by adding or eliminating certain types of food.
Our digestive tract is a 40 feet long, winding tube, consisting of several sections such as the esophagus, stomach and small and large intestine, with each section playing its own role in digestion. Many things can go wrong in this long tube, though some areas are more trouble-prone than others. The most common digestive problems include heartburn, food poisoning and vomiting, intolerance to different types of food, peptic ulcers, gallstones, diverticulosis, gas, persistent diarrhea and constipation and irritable bowel syndrome and inflammatory bowel disease. The food we eat can aggravate many of these problems while a simple change in diet can sometimes provide substantial relief.
Heartburn and Acid Reflux
The gripping pain caused by heartburn can spread into the arms, face, neck and back, mimicking the symptoms of heart attack or angina. But despite its name, heartburn has absolutely nothing to do with the heart. It is merely the result of backwash of acidic stomach contents into the esophagus.
The lower esophageal sphincter, connecting the esophagus to the stomach, opens and closes on a regular schedule. Before the swallowed food enters the stomach, the lower esophageal sphincter relaxes and then, once the food has passed by, it tightens again. Reflux happens when muscle pressure in the lower esophageal sphincter is relatively low. This pressure can be raised by protein and lowered by alcohol, smoking, caffeinated beverages and fat. When acid reflux becomes chronic, the inflamed lower esophagus becomes sensitive to many types of food, with spicy food and acidic juices being typically some of them. Moreover, heartburn can be a symptom of monosodium glutamate sensitivity or intolerance.
In order to manage heartburn you should eat small meals and you should not eat within three hours of bedtime or lie down for three hours after eating, avoid smoking, alcohol, coffee, fat and spicy food, acidic beverages and all foods that make you bloated.
Food Poisoning and Vomiting
Toxins released by bacteria happen to be the most common cause of food poisoning. In poorly canned foods, the bacterial food poisoning called botulism can cause a life-threatening emergency. In fresh foods, bacteria of the genus Salmonella are often the culprits. Bacteria usually get into food from infected animals or humans preparing the food and from animal excretions.
Symptoms that can occur in as few as four hours or as many as thirty hours after consuming infected food include nausea, abdominal pain, vomiting, fever and diarrhea. Other problems, such as cold sweats, shivering, headaches or sometimes even double vision, can accompany the problem. The first aid for food poisoning is to immediately rid yourself of the offending stuff by vomiting and then to replace lost water. No matter how unpleasant it may be, vomiting can save your life or at least bring relief.
If you have ingested a poisonous substance or if you have eaten too much for your stomach to handle or if the food you ate was infected with poisonous bacteria, your stomach sends warning signals to the brain. The brain then orders the pyloric valve between the stomach and the small intestine to relax. Churning in this area sends the infected food back up into the upper stomach and the abdomen muscles force the contents out of the stomach. The mechanism of vomiting is an example of the close connection between the digestive system and the mind.
Gluten intolerance can lead to the inflammation of the intestinal lining (the mucosa), a condition called celiac sprue or gluten-induced enteropathy. The reasons for this reaction are unknown. Gluten can be found in wheat, barley and rye. The damage caused by the body’s immune response, which induces chronic inflammation, makes it difficult for the mucosa to properly absorb nutrients. We do not know why some people develop this disorder and some don’t. Both, genetics as well as environmental factors (e.g. breastfeeding habits) seem to play their role.
Symptoms of gluten intolerance include gas, diarrhea or constipation, fatigue and weight loss. A bloated abdomen, an increased appetite and a greasy stool may also be signs of this disorder. Serious cases can lead to iron-deficiency anemia or vitamin D deficiency and subsequently to a disorder of the bones called osteomalacia.
Nutritional therapy requires the elimination of all gluten-containing foods. However, completely avoiding gluten is a difficult task in our world, where so many processed foods contain wheat flour.
Lactose intolerance is due to a deficiency of the digestive enzyme lactase responsible for processing lactose, the natural sugar in milk. The enzyme lactase breaks down lactose, a disaccharide sugar, into the two monosaccharides glucose and galactose. When you do not have enough lactase, the milk sugar lactose remains undigested and so it passes to the large intestine. The beneficial bacteria that inhabit the colon then rapidly ferment these sugars. As this process produces gas and acids, lactose intolerance can cause bloating, flatulence, cramps and diarrhea. However, many people with lactose intolerance can tolerate yogurt and hard cheese that contain active cultures because these bacteria break the lactose molecule.
It was once believed that people under extreme stress produced more stomach acid and were thus more prone to gastric ulcers. Now we know that a bacterium called Helicobacter pylori or H. pylori causes most of these ulcers (about 80%). However, not everyone who has Helicobacter pylori in their digestive tract will get peptic ulcers. Statistically, only one in four to one in eight will get an ulcerative disease. Other causes of gastric ulcers include genetic predisposition, alcohol abuse, smoking and overuse of certain medications, specifically the painkillers that can weaken the mucosa and make it more vulnerable to stomach acid.
Antibiotics and proton pump inhibitors are used to cure the ulcer. The role of proton pump inhibitors is to suppress acid production. But in people with H. pylori-induced ulcers, the use of proton pump inhibitors may need to be long-term in order to prevent recurrence. Other possible treatments include bismuth compounds and surgery whereas zinc supplements and licorice may also be helpful in preventing and treating stomach ulcers.
In addition to that there are certain nutritional steps you can take to help to manage the condition. Avoid foods and beverages which increase acid production. Refined sugar can stimulate acid production as can alcohol and coffee. Contrary to popular belief, citrus fruits and spicy foods do not appear to be harmful to the majority of ulcer sufferers. However, while drinking milk may briefly lower stomach acid concentrations, acid secretion then comes on stronger than before.
Gallstones are formed when the delicate balance of ingredients in bile is disrupted. Bile is essential for the digestion of fat and it is produced by the liver and stored in the gallbladder. It is made up of bile salts, cholesterol, lecithin and various by-products of dead red blood cells. Gallstones develop as a result of changes in the concentration of one of these elements (e.g. too much cholesterol or too much bilirubin). They become a real problem when they settle in one of the bile-carrying ducts and thus cut off the supply of bile to the small intestine. Diets high in sugar and fat and low in fiber are most likely to promote the formation of gallstones. Specific food sensitivities can also play a role.
Gas is a necessary part of the digestive process and an important warning sign of numerous disorders. About two pints of gas are produced in the human gastrointestinal tract daily, more when carbohydrate-rich foods are consumed. Production of excessive gas without eating such foods may indicate a malabsorption disorder in which the starches and sugars are not adequately digested in the small intestine and reach the colon in large amounts.
By the time food enters the large intestine, most of it should have been digested. Bacteria inhabiting the large intestine break down largely indigestible cellulose. However, when they must act upon carbohydrates, the fermentation that takes place is rapid and intense and produces gases such as methane, carbon dioxide and hydrogen. It is, therefore, logical that a diet high in fiber, starch and sugar can cause excess gas, bloating and abdominal pain.
Diarrhea and Constipation
When intestinal contents are rushed through the intestines the colon does not have enough time to absorb enough water. This usually happens when the intestinal lining is irritated or inflamed by infection. As a result, runny stool occurs. Diarrhea can also develop when excess fluid is drawn into the intestines due to illness outside the digestive system. And conversely, when intestinal contents stay in the large intestine for longer than normal, too much water is absorbed into the body and the result is hard stool.
The most common nutritional therapy for diarrhea is to replace the lost water and minerals, a process called rehydration therapy. Probiotics can be used to treat the acute diarrhea caused by gastric infections and antibiotics. Over-the-counter medications that work by absorbing water and slowing intestinal spasms are also commonly used.
There is a proven association between diet and constipation. Dietary fiber increases stool weight, frequency and water content. The soluble fibers containing pectin and mucilage found in bananas and citrus fruits have the least effect on the bowels whereas insoluble fibers found in foods such as bran, whole grains, seeds, nuts, brown rice, dark leafy vegetables, root vegetables etc. have the most and they can be used safely to prevent constipation.
The large intestine contracts three to four times a day, usually during or just after eating. This contraction moves the contents of the intestine towards the rectum for disposal. Fiber in the diet promotes contractions and keeps muscular walls fit. When the diet lacks sufficient amount of fiber, the walls of the lower intestine thicken, the passage narrows and the pressure on the walls grows. Under high pressure the weaker sections of the walls may begin to bulge. The outpouchings that occur are called diverticula and the medical condition which arises is known as diverticulosis. When the diverticula become inflamed, a life-threatening condition known as diverticulitis can occur.
Diverticula occur most often in older people while they are uncommon in people below the age of 40. Most patients with diverticulosis have few or no symptoms at all. Symptoms of diverticulitis typically include alternating diarrhea and constipation, tenderness and pain in the colon and gas. In order to thwart the progression of diverticulosis you have to eat a high-fiber diet which may also help to prevent the disease from occurring. Patients with diverticulosis may also benefit from antispasmodic drugs. However, when diverticulitis occurs, antibiotics or even surgery may become necessary.
Irritable Bowel Syndrome
Irritable bowel syndrome, also known as spastic colon or irritable colon, is a digestive disorder that affects the large intestine. Its symptoms include diarrhea and constipation, gas, bloating, passage of non-bloody mucous and a feeling of incomplete rectal emptying. The symptoms of irritable bowel syndrome remind of those of inflammatory bowel disease though no inflammation occurs.
This disorder has no known cause but a variety of factors seem to play a role. People whose family members have the disease are more likely to develop it. Irritable bowel syndrome often accompanies psychological disorders such as depression. Other factors that may be involved include allergy or intolerance to certain foods, emotional stress, hormonal changes in women and other gastrointestinal diseases. Foods and their components that are known to aggravate the symptoms of irritable bowel syndrome include chocolate, fats, beans, soybeans, peanuts, spices, cabbage, coffee, alcohol, milk and some lactose-rich dairy products, wheat (gluten) and sorbitol.
If certain foods are the cause of your problem, you need to eliminate them from your diet. Medications used to relieve the symptoms of irritable bowel syndrome include fibre supplements, over-the-counter anti-diarrheal medications, antispasmodic medications and in certain cases also antidepressants and antibiotics. Medications specifically designed to treat irritable bowel syndrome include alosetron (Lotronex) and lubiprostone (Amitiza) but they can only be prescribed to female patients.
Inflammatory Bowel Disease
Inflammatory bowel disease is a condition involving chronic inflammation of the colon and small intestine. There are two major forms of inflammatory bowel disease: ulcerative colitis and Crohn’s disease. The cause of the disorder is unknown although genetic predisposition and immune system malfunction are suspected to play a role. Inflammatory bowel disease is very difficult to treat as no specific preventive or curative measures stand out above the rest. Symptoms of both forms of the disease include abdominal pain, diarrhea, fatigue and weight loss. Some patients may be malnourished since they lack an appetite and are unable to absorb sufficient amount of nutrients from the intestines.
Ulcerative colitis is due to development of ulcers on the lining of the colon (large intestine). Doctors sometimes prescribe a diet low in residue along with multivitamin supplements for ulcerative colitis. Foods to avoid include oranges, apples, berries, celery, tomatoes, cabbage and raw egg whites.
Unlike ulcerative colitis, Crohn’s disease can occur anywhere along the digestive tract, although it is most often found in the lower small intestine. In the affected areas, ulcers dot the thickened intestinal wall, often deepening to the point of perforation. Crohn’s disease typically affects young people in their 30s and 40s. There seems to be no medical agreement on a specific diet for treating of Crohn’s disease.
The first step in the treatment of inflammatory bowel disease involves the use of anti-inflammatory medications. When these cannot control the symptoms of the disease, immune system suppressors will be prescribed. Patients with fever may be also given antibiotics. Other medications used to control the symptoms of inflammatory bowel disease include anti-diarrheal drugs, painkillers and dietary supplements. If all measures fail, the doctor may recommend surgery.
Where to Find Related Information: Help & Hope for Children with Digestive Disorders