Relief from the Digestive Blues

"Food, glorious food," begins the chorus of young boys in Oliver, the musical based on the Charles Dickens's classic, Oliver Twist. "Hot sausage and mustard. While we're in the mood, cold jelly and custard!" the residents of the orphanage continue in their ode to an imaginary feast, an antidote to their daily gruel.

Although the poorhouse fare may be foreign to many, the cravings evoked in the boys' ditty conjure up the passionate relationship that many of us have with food and eating. Whatever the depth of that relationship, a delectable dish often remains in memory with much more potency than any sort of digestive upset the treasured food may have caused.

Even those who aren't enamored with food but eat simply because it's necessary may wolf down their lunch only to find it biting back a couple hours later. And what do too many of us do when our stomachs bloat, cramp, or send us running to the bathroom? We reach for an elixir, a mint, pill or potion to tame the unquiet tummy.

Not that there's anything wrong with seeking some quick relief. But if you're suffering from chronic discomfort and find yourself diving for the antacid on a regular basis, you should probably see a doctor to make sure you don't have an infection or organic disease. If medical tests fail to point to any culprit, you may be diagnosed with a "functional" digestive disorder such as irritable bowel syndrome (IBS) or chronic constipation that can't be traced to any organic disease. In this case, changing your lifestyle is usually the best way to permanently free yourself from digestive distress.

Functional disorders such as irritable bowel syndrome, heartburn, gas, and chronic constipation and diarrhea are often connected to life in the 21st century: too much rushing around in traffic, grabbing fast food, skipping meals, then unwinding with a big dinner and a few cocktails late at night.

Diet, in fact, has such a strong connection to so many of these ills that stomach specialists often tell their patients to keep a log of every bit of food or drink they consume so they can pinpoint the source of their distress and make some lasting changes.

The daily diary

People who have had stomach problems for months or years often have no idea what foods trigger their pain. To figure out possible sources, Gary Gitnick, MD, chief of the division of digestive diseases at the University of California at Los Angeles School of Medicine, advises that the food journal include when you eat something, how much you eat, where you ate it, if you were doing anything else at the time, and any symptoms you're feeling. (He also suggests recording your mood and emotions at the onset of any digestive symptoms.) Your diary should include everything you put in your mouth, including things like chewing gum, candies, and mints.

After a few weeks of keeping the diary, you can get a better sense of which foods are unfriendly to your digestive tract, and begin creating a diet that is well-balanced and tailored to your needs. You may also want to consult with your doctor or a nutritionist to find out what foods are most likely to produce the symptoms you have. Removing a food item from your personal menu doesn't necessarily mean avoiding it altogether. It may mean cutting it out until the symptoms go away.

Foods that bite back

If you have heartburn (also called acid indigestion) -- with the classic symptoms of a bitter taste in your mouth, a burning sensation in the back of your throat, or pain in your upper abdomen -- there are foods and beverages you might consider avoiding. These include drinks containing caffeine such as coffee, cola drinks, black tea, and hot chocolate. Also avoid teas, candies, and gum with mint. Oil of peppermint relaxes the valve between the esophagus and stomach and allows stomach acid to back up into your esophagus. High-acid foods such as lemons, oranges, grapefruit and tomatoes may also aggravate your condition. Cutting back or eliminating your alcohol intake may help, too, as will eliminating nicotine.

If you suffer from bloating or excess gas, you may want to steer clear of the top 10 gassiest foods known to humans: cabbage, cauliflower, broccoli, brussels sprouts, turnips, dried beans, onions, garlic, leeks, and milk products (for people who lack an enzyme that digests milk). In trying to unearth the source of a pain or discomfort, bear in mind that some reactions to foods are almost immediate, like heartburn; others, like gas, can hit you hours after you ate the offending food. (Each individual is different, however, so you may be able to tolerate some gas-producing foods that others can't.) Carbonated drinks, olestra (artificial fat), and sorbitol (an artificial sweetener in candy and chewing gums) can also result in excess gas, as can chewing any kind of gum (because you tend to swallow air).

Having a cluster of symptoms that includes abdominal pain, bloating, and constipation alternating with diarrhea may lead to a diagnosis of irritable bowel syndrome. As far as foods go, the American College of Gastroenterology (ACG) recommends avoiding the gas-producing foods listed above. Also steer clear of carbonated drinks, which can produce more gas, and try eliminating dairy products. Intolerance to milk sugar, or lactose, is seen in 40 percent of patients with IBS, according to the gastroenterologists' organization. (If you're indeed intolerant of dairy products, you may need calcium supplements.) Consuming fiber in the form of wheat bran or other types might also be helpful, according to the ACG.

If you have chronic diarrhea, the top foods to avoid are the artificial sweetener sorbitol, prune juice or other fruit juices, unpeeled fruits (such as apples, grapes, plums or pears), fatty or fried foods, caffeine, raw vegetables, and milk products (if you lack the enzyme lactase). Olestra, an artificial fat found in some potato chips and other processed foods, can cause bouts of diarrhea and "leakage" in susceptible individuals. Foods that are helpful are the so-called BRAT foods -- as in bananas, rice, apples (without skin or applesauce), and toast. Fiber supplements such as Metamucil, made from vegetable powder, can also help stop diarrhea by making stools bulkier.

For those who suffer from constipation, lasting relief often comes from the grocery store, not the pharmacy. Each year, Americans spend $725 million on laxatives, according to the American Gastroenterological Association (AGA), which notes that many times they're unnecessary or even harmful. The main cause of constipation may be a diet high in animal fats and refined sugar and low in fiber from vegetables, fruits, and whole grains. There are other causes of constipation -- including medications, pregnancy, hormonal disturbances, and travel. One major cause cited by the AGA is laxative abuse. The more laxatives you take, the more your body depends on them to function until finally your intestine becomes insensitive and fails to work properly.

If you suffer from functional constipation, you can often find relief getting regular exercise, increasing your intake of fluids (some experts advise drinking eight or more 8-ounce glasses of non-caffeinated liquids a day), and eating a diet rich in fruits and vegetables. Fiber supplements help by making stools softer and more bulky, as long as you always take them with one and preferably two glasses of water.

Get moving

Whatever your condition, consider adding some form of exercise to your routine. It's not only good for you on many other fronts, but exercise also can help keep your digestive tract buzzing along as it should. "I think that most doctors would agree that regular exercise helps promote normal intestinal function, which in turn helps pass gas, reduces bloating and cramping, and results in more regular bowel movements," writes Gitnick.

Just remember that certain types of digestive problems may preclude some forms of exercise. For example, Gitnick notes that people who suffer consistently from heartburn should refrain from jarring or high impact exercises. Instead of aerobic dancing, jogging, or the step machine at the gym, Gitnick suggests walking or swimming as an alternative. Thirty minutes to an hour a day should be enough, and if you have to break it up into 10- or 15-minute segments each day at first, that's okay.

For people with severe symptoms, exercise and dietary changes may not be enough; prescription medicine may be necessary. If you have irritable bowel syndrome and experience extremely painful abdominal cramps, your doctor may prescribe anti-spasmodic drugs. If heartburn and sores in the esophagus are your problem, your doctor might recommend taking medication known as a proton-pump inhibitor, which blocks the production of stomach acid.

Another key to better digestive health is reducing your stress. If your day is shaped by stress, you may want to learn a relaxation technique to calm your nerves, whether it's some form of meditation, a breathing exercise or just listening to music. If you make exercise, relaxation, and dietary changes a part of your routine, you'll probably find that the stomach troubles that were once part of your daily life are fading into the past.

Further Resources

National Digestive Diseases Information Clearinghouse
(800) 891-5389
http://digestive.niddk.nih.gov

American Dietetic Association
National Center for Nutrition and Dietetics
(800) 877-1600 www.eatright.org

American College of Gastroenterology
(301) 263-9000
http://www.acg.gi.org

National Institute of Diabetes and Digestive and Kidney Diseases
(301) 496-3583
www2.niddk.nih.gov

References

Gitnick, Gary, Freedom from Digestive Distress, Three Rivers Press, New York.

American College of Gastroenterology, Consumer Health Guide to Irritable Bowel Syndrome.

American Gastroenterological Association, Consumer Guide to Constipation.

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