by Ronald Hoffman, M.D., CNS
Baby boomers use a lot of antacids to deal with many different types of GI problems. The old-fashioned Rolaids commercials with the "drip-drip-drip" and the claim that it "consumes forty times its weight in excess stomach acid" is our model solution for any GI problem. It's a model that has successfully sold billions of dollars of over-the-counter antacids. Now, baby boomers who fear osteoporosis are exhorted to take Tums, giving new life to the old remedy. Now, powerful acid blockers are available over the counter that were formerly obtained only by prescription.
The fact is, however, that most upset stomachs are caused not by too much stomach acid but by the wrong food or too much food. If the culprit is identified or destructive eating patterns are changed, the problem can virtually always be corrected without antacids.
The other problem with using antacids for an upset stomach is that they don't work. "What?!" you say. "I can tell the difference after I take it!" Actually, unless you have an ulcer, this is probably a placebo effect. Antacids were clinically proven ineffective by a Swedish study in 1986. In fact, antacids will sometimes cause your stomach to produce more acid -- a condition called acid rebound, which worsens your GI problem. Also, antacids change the pH environment of the gut, potentially causing an imbalance of friendly flora and putting you at risk for infection by the unfriendly types. Some believe that antacids may even help set the stage for infection with Helicobacter pylori, the bacterium that causes ulcers.
We are a nation of overeaters. "All you can eat" dinners and smorgasbords were the dining rage of middle America as we grew up, and they typify the erroneous philosophy that more is better. Even in our supposedly health-conscious age, statistics have shown that our average yearly food intake actually increased during a recent ten-year period. Overeating leads to a host of GI problems: abdominal pain, bloating, gas, diarrhea, constipation, hemorrhoids, and overnutrition. How many of us have not suffered from one or more of these consequences at some point when we've overindulged on that special occasion? Many of us should ask ourselves whether we are overindulging regularly and experiencing these symptoms all the time. If you combine chronic overeating with your food allergies, you can imagine why you're miserable!
In the absence of purging or bulimia, obesity is the most obvious complication of overeating. Commercial weight-loss programs are a billion-dollar industry in this country. An estimated 34 million Americans aged 20 to 75 weigh more than the recommended figures for their age and height -- a startling 26 percent! Of these, a high percentage are food addicts. According to medical experts, an increase of just 20 percent over ideal body weight is considered a bona fide health hazard.
Chemical ills: Caffeine, Alcohol, and Smoking In addition to eating too much, Americans bombard their systems with nonfoods that are nothing but pure mood-changers.
Caffeine: Some people pour huge amounts of caffeine into their GI tracts. Caffeine is highly addictive stuff, with distinct physiological withdrawal symptoms, including headaches. Besides coffee and tea, many popular soft drinks have a high caffeine content. Other sources of hidden caffeine are chocolate and cocoa products, pain relievers like Anacin and Excedrin, and many over-the-counter cold remedies. (Make sure you read the ingredients on the labels!)
As a drug, caffeine stimulates gastric secretions, thereby increasing appetite. It also overstimulates the normal rhythmic contractions of the bowels, causes malabsorption of nutrients -- especially calcium and magnesium -- and blocks prostaglandin production.
In addition to caffeine, the oils contained in coffee -- even decaffeinated coffee -- can have powerful effects on the digestive tract, acting to increase acid production in the stomach. This can contribute to a host of GI problems, including ulcers and irritable bowel syndrome, also known as spastic colon. People vary widely in their tolerance for caffeine. Some can drink two or three cups a day with no ill effects; others would be well advised to swear off it completely.
A word of caution about quitting caffeine: taper it off slowly over several days. Gradually switch from caffeinated to decaffeinated beverages. Cut the caffeine beverages back one-half cup a day, replacing them with decaffeinated. (If you drink three cups of coffee every day, go to two and a half cups the next day, then two cups, then a cup and a half, etc.) If you start to get headaches, taper it even more slowly.
Alcohol: Although alcohol can deliver some health benefits in small quantities, in excess it acts as a dangerous toxin in the human body. Excess alcohol can inflame the lining of the esophagus, stomach, and intestine; it can sterilize the gut by killing bacteria and normal intestinal flora, leading to indigestion and diarrhea. Alcohol also impairs digestion by reducing stomach acid and digestive enzymes. Because it contains calories, alcohol consumed at high levels can act as an appetite suppressant, though generally it relaxes you and promotes appetite. Finally, excess alcohol use leads to nutritional deficits as well: it is the number-one cause of malnutrition in otherwise healthy people.
If you have digestive difficulties that may be related to alcohol use, try cutting back and see whether there's improvement. If you're unable to cut back or stop drinking, consult your physician and/or Alcoholics Anonymous.
Cigarettes: Cigarette smoke contains over 150 poisonous gases, one of which is nicotine -- a very powerful stimulant that is highly addictive. Why mention cigarettes here? Because smoking contributes to indigestion or heartburn by increasing the amount of acid produced in the stomach and decreasing the amount of bicarbonate produced by the pancreas. This bicarbonate is essential to neutralize stomach acid. Consequently, smokers are more prone to gastric and duodenal ulcers than are nonsmokers. Smoking also accelerates gastric emptying and intestinal motility.
An unsettled age
The factors outlined above are the major causes of gastrointestinal distress for the healthy individual. It is possible to completely eradicate most GI complaints by avoiding cigarettes and excess coffee or alcohol, improving the diet, reducing the amount of food eaten, and stopping the use of antacids. There are some additional remedies for the common gastrointestinal symptoms, including indigestion, constipation, diarrhea, and flatulence.
Aloe vera and bismuth (the active ingredient in Pepto-Bismol). This is helpful for indigestion and reflux.
Supplemental hydrochloric acid, generally in the form of betaine hydrochloride. Paradoxically, heartburn and reflux are sometimes caused by insufficient production of hydrochloric acid.
Staying vertical and not lying down for one to one and a half hours after meals.
DGL, deglycerrhizinated licorice, acts as a natural antiinflammatory.
Herbal treatments. For occasional relief of constipation, take a tablespoon of goldenseal, buckthorn bark, flaxseed, or linseed in a glass of water. (But be careful -- certain herbal laxatives can be habit-forming, too!)
Prunes (the old standby) or Rhubarb. Fresh rhubarb stalks work wonders for constipation.
Colonics. Enemas have been used since ancient times as a cure for constipation. Colonics are thorough enemas that gently cleanse the entire colon.
Magnesium can be helpful in two ways. It restores tone to the muscles of the digestive tract, taking them out of spasm and enhancing peristalsis, which is the natural pulse that moves food through the intestine. It also acts as a natural laxative by pulling water into the intestine, in addition to its physical effect. The standard remedy, Milk of Magnesia, is magnesium hydroxide, but I prefer magnesium citrate. In very heavy doses, magensium citrate is a physic -- a powerful laxative -- but in moderate doses can gently aid the digestive process.
Recommended Dosage: 150 mg two or three times daily. (Caution should be exercised by the elderly or those with diminished kidney function as revealed on a standard blood test.)
Rule out infection. If your diarrhea won't go away after a few days, you should consult a doctor and rule out a parasitic or bacterial infection, or an inflammatory condition like ulcerative colitis or Crohn's disease.
Avoid laxative foods. These include foods like raw salads, most dairy products (except yogurt), raw vegetables and fruits, beans, fruit and vegetable juices, caffeine, and carbonated beverages.
Eat the "BRAT diet." Bananas, rice (white), applesauce, and tea (herbal, especially chamomile) -- this food list is often recommended by pediatricians for children with diarrhea.
Eat yogurt with live culture of acidophilus or bifido, or take acidophilus supplements. (Flavor yogurt with cinnamon or vanilla rather than eating the highly sweetened fruit flavors.)
Eat cooler, lukewarm (not cold) foods. Heat speeds up the movement of food through the intestine.
Use natural medications. Certain natural clays can help absorb toxins from bacterial overgrowth and also firm up the stool. Bentonite is one of these, and so is kaolin, which is found in the over-the-counter remedy Kaopectate (which also contains pectin, a soft fiber.) These are not toxic. If you look at them under a microscope, you'll see particles that look like little golf balls with dimples, which are sites that attract the diarrhea-causing endotoxins produced by bacteria in the intestine.
Take a bismuth compound. Pepto-Bismol is a good over-the-counter remedy that contains both bismuth and pepsin. You can also ask your doctor for a prescription-only pure bismuth citrate. I often prescribe a compound called "B and B": a mixture of bentonite and bismuth.
Avoid antimotility drugs. Drugs like Lomotil, Imodium, and some others work by paralyzing the nerve endings in the bowel to slow intestinal transit time, but they do not remove the diarrhea-causing toxins and can actually cause them to linger.
Make sure to see a doctor if your diarrhea won't go away after a few days. Infants, the very elderly, and the immunosuppressed should be seen right away.
The present vogue for high-fiber, whole-grain vegetarian dishes is generally all to the good, but it can have an annoying side effect. Here are some tips to avoid flatulence:
Food Combining: Avoid mixing sugar, fruit, or fruit juice with starches. The resulting mix can ferment in your gut, causing flatulence and bloating. Dishes to avoid: sweetened granola with fruit, sweetened oatmeal with raisins, fruit pies, fruit muffins, "low-fat" cookies sweetened with fruit juice.
Activated Charcoal: Tablets of activated charcoal are effective in relieving gas, and the charcoal is not absorbed by your system. (It will also combine with vitamins and medications, so use your judgment.)
Digestive Enzymes: Beano is one well-known product that contains a digestive enzyme prepared from Aspergillus, a natural vegetarian source. Some people are allergic to Aspergillus, a fungus related to Candida, and people who have Candida infections would be advised against using it. But it's generally helpful for people who have difficulty digesting carbohydrates. Another option is to use a product containing pancreative enzymes from extract of bovine or pork pancreas, although these may be less appealing to strict vegetarians.
Chew Slowly: Chew your food as slowly and as many times as you can.
Eliminate Sorbitol: Dietetic candies and gum can contain sorbitol which can't be digested and causes gas.
Eliminate Milk Products: Except for yogurt and certain cheeses many people are unable to digest milk, a condition called lactose intolerance. Are you one of them? Try eliminating milk and milk products from your diet for a week, and see if your symptoms are alleviated. Try Lactaid milk as an alternative.