Category Archives: indigestion

A Natural Approach to Heartburn

As a nutritional therapist I have recently noticed a growing number of new clients taking a particular type of heartburn medication called ‘proton pump inhibitors’ or PPIs. In my experience, PPIs are a concern because they can sometimes do more harm than good.

PPIs, such as omeprazole and lansoprazole, work by suppressing the formation of stomach acid. Contrary to popular belief, heartburn is rarely caused by excess stomach acid and we need stomach acid. It is required for the proper digestion of proteins and carbohydrates, for absorption of nutrients and for protection against harmful bacteria. Without stomach acid, our digestion and immune system is compromised. For this reason PPI use has been linked with deficiencies of nutrients such as B12 and magnesium. as well as increased risk of bone fracture and bacterial overgrowth in the digestive system (1-4).

So what really cases heartburn? Most often, the problem is caused by a problem with the Lower Esphageal Sphincter (LES) – a valve between the stomach and oesophagus which prevents stomach acid from escaping upwards. Even if our levels of stomach acid are low, we can experience heartburn if this valve is not functioning as it should. The proper functioning of this valve can be affected as we age. It can also be affected by the types of foods we eat, and our eating patterns and behaviours.

A Natural Approach to Heartburn

Those experiencing heartburn can benefit by addressing their diet. Including protein with each meal is helpful, because protein encourages the LES to close properly. On the other hand, fat has the opposite effect, and so fatty foods and meals are best avoided. Fizzy drinks, alcohol, chocolate and smoking also ‘loosen’ the LES, and so are best avoided.

Other foods can irritate the lining of the oesophagus, especially when acid reflux has already made this tissue sensitive. These foods include orange juice, tomatoes and spicy foods. Until heartburn is resolved, it can be helpful to avoid these particular foods.

Helpful foods include sources of soothing pectin such as almonds, apples, apricots plums, carrots and strawberries. A teaspoon of Manuka honey, taken twenty minutes before a meal, may also help to reduce symptoms by coating the oesophageal lining.

Simple lifestyle changes can also be beneficial. Wearing loose-fitting clothing, eating slowly and chewing thoroughly are all helpful measures. Eating small meals and remaining upright for at least three hours after eating can also eliminate symptoms of heartburn.

Slippery Elm may help coat and protect the digestive tract.

Nutritional supplements are often used in heartburn in order to protect and repair the delicate tissue of the digestive tract and to combat bacterial overgrowth. Supplements which coat and protect the digestive tract are known as ‘demulcent’ nutrients, and these include slippery elm, marshmallow root. Herbal preparations such as this have been found to improve symptoms of heartburn (5). In clinic I have also had success using deglycyrrhizinated licorice (DGL) supplements as a powder or chewable tablet before meals. DGL seems to support the mucosal barrier, promoting healing of inflamed tissues. Glutamine, an amino acid used as fuel for the cells lining the digestive tract (6), may be also beneficial. Finally, a probiotic preparation can provide useful support, especially for those taking PPIs. Treatment with probiotics is believed to help the small bowel problems such as inflammation and bacterial overgrowth seen in those taking PPIs (7).

For those looking for a more natural approach, one of my favourite formulations is Patrick Holford Digest Pro, which provides glutamine, digestive enzymes and probiotics. Biocare’s Slippery Elm Intensive is another promising formulation combining marshmallow, DGL and slippery elm alongside other nutrients designed to support the health of the digestive tract. Alongside the right dietary and lifestyle choices, supportive supplements such as these may represent a sensible approach to addressing heartburn for those wishing to avoid long-term PPI use.

References

1. Jameson RL et al (2013) Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency. JAMA 310(22):2435-2442

2. MHRA (2012) Proton Pump Inhibitors in Long-Term Use: Reports of Hypomagnesia. Drug Safety Update 5:9. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON149774

3. Yu EW et al (2011) Proton Pump Inhibitors and Risk of Fractures: A Meta-Analysis of 11 International Studies. http://dx.doi.org/10.1016/j.amjmed.2011.01.007

4. Lombardo L et al (2009) Increased Incidence of Small Intestinal Bacterial Overgrowth During Proton Pump Inhibitor Therapy. http://dx.doi.org/10.1016/j.cgh.2009.12.022

5. Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004;20:1279-87.

6. Reeds PJ, Burrin DG. Glutamine and the bowel. J Nutr 2001;131:2505S-8S.

7. Wallace JL et al (2011) Proton Pump Inhibitors Exacerbate NSAID-Induced Small Intestinal Injury by Inducing Dysbiosis. Gastroenterology. July 2011.

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Probiotics may be useful in preventing festive indigestion

Christmas parties and festivities are ongoing at this time of year and this often means large meals and plenty of rich food.  Indigestion is a common side-effect of over-indulgence for many people.  Indigestion will typically occur 1-2 hours after eating and symptoms may include:

* Abdominal Pain centred in the upper abdomen
* Rumbling noises
* Excessive wind/flatulence
*A feeling of fullness, distension of the stomach or bloating

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.

It may sound simple but chewing is really important when eating a large meal.  Chewing food properly before swallowing it really does help prevent indigestion.  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.

Another good way to prevent indigestion is to avoid drinking a lot of fluid during a meal.  Excess liquid with a meal seems to dilute stomach acid and enzymes which digest food, making the digestive process a little less efficient.

Probiotics can help with festive indigestion
Probiotics can help with festive indigestion

A recent study (1) has found that taking a probiotic supplement is also a good way of reducing indigestion related symptoms.  The study was well designed and involved 61 adults who were given a supplement containing probiotic bacteria or a placebo (‘dummy’) pill for four weeks.  The researchers wanted to look at the effects on indigestion symptoms such as abdominal pain, distention, flatulence.  None of the participants had any diagnosed gastrointestinal diseases.

Individuals who got the probiotic supplement(1) had significant improvements in their abdominal pain scores and some improvement in their feelings of abdominal distension.  The authors of the research study conclude that the probiotic product “was effective in improving the quality of life and reducing gastrointestinal symptoms in adults with post prandial [after eating] intestinal gas-related symptoms and no GI [gastrointestinal] diagnoses”.

Taking a supplement containing prebiotics and probiotics regularly may be useful in preventing symptoms such as pain, bloating and flatulence.  These supplements are safe to take long term and have also been linked to improving many digestive complaints as well as benefiting health in other ways.

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.  Often supplements will contain both prebiotics and probiotics together and these may well be worth trying for a few weeks to see if indigestion symptoms are helped.

Take time to really enjoy your meals this Christmas.  Not rushing when eating not only adds to the enjoyment but can actually help prevent overeating since the stomach has time to send signals to the brain to indicate feelings of fullness.

(1)Kalman DS et al.  2009.  A prospective, randomized, double-blind, placebo-controlled parallel-group dual site trial to evaluate the effects of a Bacillus coagulans-based product on functional intestinal gas symptoms.  BMC Gastroenterol.  18;9:85.

Written by Ani Kowal

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Natural ideas for tackling festive indigestion

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

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