I do hope you all had a fabulous Christmas?  Plenty of food has been consumed in my household and, with New Years Eve fast approaching, there may be plenty more tasty treats in the planning.  Indigestion is possibly on the menu in many homes, however there are natural ways to prevent and overcome this uncomfortable problem.

Indigestion, sometimes referred to as dyspepsia, is a general term for impaired stomach/digestive functioning occurring 1-2 hours after eating.  Symptoms may include:
Abdominal Pain centred in the upper abdomen
Rumbling noises
Excessive wind
A feeling of fullness or bloating

Indigestion commonly occurs after eating a large meal, or rich, fried or spicy food.  Alcohol, coffee, cigarette smoking and some pharmaceutical drugs such as aspirin and ibuprofen can also irritate the digestive system and cause indigestion.  During stressful situations or stressful periods of time we are also more susceptible to this complaint.

Our bodies are far more adept at digesting small, regular quantities of food rather than single huge meals.  However, if you are going to be consuming a large meal there are a few things you can do to minimise discomfort.  Chewing is a simple, yet highly effective, strategy for indigestion avoidance.  Our saliva contains enzymes that start digesting food within the mouth, even before it hits the stomach.  Chewing food properly enables these enzymes to mix thoroughly with our food.  Chewing also physically breaks food up into smaller pieces which make it easier to be further broken down by our stomach acid.  Taking the time to chew food until it becomes almost creamy in consistency before swallowing is an effective method of preventing indigestion and also allows us to enjoy what we are eating, really taste the flavours and savour them.  Taking time over a meal increases the enjoyment value, usually helps us not to overeat (as it is easier to know when we are full) and can help prevent indigestion.

Whilst eating try not to drink a lot of fluid.  Excess liquid with a meal can dilute stomach acid and enzymes which digest food making the process a little less efficient.  Carbonated, fizzy, drinks seem to be the worst culprits. 

Prebiotics and Probiotics
Studies (1,2) are beginning to show that probiotics and prebiotics can aid healthy digestion and prevent indigestion.  Taking a supplement containing prebiotics and probiotics regularly can prevent symptoms such as pain, bloating and flatulence within as little as 2 weeks

A probiotic is a supplement containing live friendly bacteria which aim to improve intestinal bacteria balance.  Probiotics are available as yoghurts, fermented milks, fortified fruit juices and freeze dried capsules/powders.   

A prebiotic is a food that stimulates the growth of the beneficial bacteria already present in the colon.  Fructooligosaccharides (FOS) which can be bought as powders are the most common prebiotics available.  Natural prebiotics can be found in asparagus, onion, chicory
and garlic. 

Digestive enzymes
Many people will reach for antacids in the hope that they will aid their indigestion.  However, antacids are used to damp-down the stomach’s acid (hydrochloric acid) production and in many instances indigestion is actually linked to insufficient acid production in the stomach.  Taking an antacid could exacerbate the underlying cause of indigestion.  If, after a large meal, you feel uncomfortable with indigestion it may be helpful to take a supplement containing a mixture of natural digestive enzymes such as amylases, which digest carbohydrates, lipases, which digest fats, and proteolytic enzymes which digest proteins.  This will help your body to digest the food within your system.  I don’t suggest these supplements need to be used long term but they may well be helpful after a large meal if indigestion starts to make you feel uncomfortable.

Digestive enzyme use should be avoided in cases of gastritis, inflammation of the stomach lining, and/or ulceration as they will exacerbate the condition. 

Artichoke leaf extract
Studies (3,4) show that artichoke leaf extract supplements are useful for individuals who commonly suffer with indigestion.  It appears that after taking the supplement for six weeks individuals report their symptoms are improved and they feel more comfortable in general.  

Finish off the meal with some peppermint or ginger tea
A review published of studies and papers was published this year (5) which indicates that peppermint oil can be effective in reducing abdominal pain, flatulence and diarrhoea.  It seems to work by reducing spasms in the digestive system.  Peppermint tea contains peppermint essential oil and it may be worth sipping on some peppermint tea after a meal – it could aid in minimizing indigestion problems. 

Another recent review paper (6) indicates that ginger may well be helpful in easing indigestion.  Ginger does contain many compounds that seem to have various effects in the body and is particularly useful in relieving feelings of nausea.  Drinking some ginger tea after a meal could be worth a try!

Please see a doctor if your indigestion persists over several days, is experienced after every meal, becomes worse over time, if you vomit, you lose your appetite, or if you start to lose weight. These symptoms may indicate an underlying gastric disorder.  Apart from poor digestion or a large meal, another common cause of indigestion is an ulcer in the stomach or upper intestines and I hope to write about digestive ulcers in 2009.

Take the time to really enjoy your New Year celebrations!

(1)Kocian J.  1994.  [Lactobacilli in the treatment of dyspepsia due to dysmicrobia of various causes][Article in Czech].  Vnitr Lek.  40(2):79-83
(2)Bittner AC et al.  2007.  Prescript-assist probiotic-prebiotic treatment for irritable bowel syndrome: an open-label, partially controlled, 1-year extension of a previously published controlled clinical trial.  Clin Ther.  29:1153-1160
(3) Marakis G et al.2002.  Artichoke leaf extract reduces mild dyspepsia in an open study.  Phytomedicine.  9(8):694-699.
(4)Holtmann G et al.  2003.  Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial.  Aliment Pharmacol Ther.  18(11-12):1099-1105.
(5) Herbal remedies for dyspepsia: peppermint seems effective.  2008.  Prescrire Int.  17:121-123
(6)Ali BH et al.  2008.  Some phytochemical, pharmacological and toxicological properties of giner (Zingiber officinal Roscoe): a review of recent research.  Food Chem Toxicol.  46:409-420

Written by Ani Kowal

Peppermint tea is one of my favourite refreshers, so I was interested to read a paper(1) published in the latest issue of the British Medical Journal linking peppermint in the treatment of IBS (irritable bowel syndrome).  Back in August I wrote three lengthy pieces investigating IBS and this paper provides a nice update. 

The key to IBS is to try and find a cause to treat, this is very individual and may be linked to stress, emotions, food intolerances and more.  Any sort of diagnosis needs to be done in conjunction with a health professional.  However, it is always good to have some idea of the natural remedies that can help reduce symptoms.  The research in the British Medical Journal was a review of randomised controlled trials looking into the effect of fibre, antispasmodics (prescribed medication) and peppermint oil in the treatment of IBS.

Fibre
Traditionally, people with irritable bowel syndrome were instructed to increase their daily intake of dietary fibre, because of its potentially beneficial effects on bulking stools and moving them through the intestine more quickly (speeding up intestinal transit time).  However, many individuals with IBS found this advice unhelpful and some people reported that it made the condition worse.  The study looked at types of fibre and their usefulness in IBS treatment.  The investigators found that bran fibre (usually from wheat) had no effect on IBS symptoms.  However, ispaghula fibre, a soluble fibre derived from plaintain, did have a beneficial effect and reduced persistent symptoms of IBS.  The authors of the study indicate that ispaghula may be particularly beneficial to individuals who suffer constipation as one of their major IBS characteristics.

Ispaghula husk is readily available to buy from health-food stores and pharmacies as well as online. 

Antispasmodics
Antispasmodic medications attempt to reduce spasms in the digestive system.  Doctors frequently prescribe these types of medication for IBS symptoms, particularly when an individual is suffering from bloating and pain.  In the study 12 drugs were assessed.  Only 5 of these were shown to bring about a relief for IBS symptoms.  Some of the drugs, which are specifically licensed for use in IBS e.g. mebeverine, dicycloverine and alverine actually seemed to have very little evidence behind them.  The best evidence seemed to be for a drug called hyoscine.  The most common side effects for this type of medication are dry mouth, dizziness, and blurred vision, but none of the trials reported any serious adverse events.

It is not really known why antispasmodics are helpful for IBS sufferers.  The authors of this study note that “The biological rationale for the efficacy of antispasmodics is unclear.....antispasmodics may act by reducing colonic contraction and transit time and therefore pain and stool frequency”.  In light of the evidence discussed in this medical journal I would think that further studies are necessary to investigate the use of these drugs in patients with IBS to see if they really are helpful.

Peppermint oil
There were fewer available studies to analyse for the use of peppermint oil.  However, the studies that have taken place with this remedy show consistently positive results for use in IBS patients.  In fact peppermint oil appeared to be the most effective treatment for IBS when assessed via a measure called NNT, or number needed to treat, a measure of the number of individuals that need to be treated for one to get significant benefit.  Peppermint appears to have natural antispasmodic properties and is widely available over the counter in capsule form.  Larger trials of this traditional remedy would be welcome.

The authors conclude their paper by talking about the current guidelines for the management of IBS, they discuss the fact that these guidelines have been set around previous studies that have potential methodological flaws.  In the UK “Antispasmodics are recommended as first line treatment, particularly when pain and bloating are the predominant symptoms, although which of these drugs should be preferred is not stated”(1).  They also suggest that the current clinical guidelines be updated to take into account their findings.

(1) Ford AC et al.  2008.  Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ.  337:a2313

Written by Ani Kowal