By Nicole Kafka, M.D., Board-Certified Colorectal Surgeon
Living with a gastrointestinal (GI) disorder has its challenges in a world of fast food, carbonated and sugary beverages, and high-stress living, and the most important step for a person to take is to consult a doctor who can diagnose the condition and recommend the appropriate treatment – from diet therapy to more specialized care from a gastroenterologist or colorectal surgeon.
Among the most common disorders, which affect about one in four people in North America, are lactose intolerance, irritable bowel syndrome, hemorrhoids, chronic constipation, inflammatory bowel disease, and diverticulitis.
The good news is that each of these common GI conditions can usually benefit through simple changes to diet and lifestyle.
Lactose intolerance is a condition when a person is unable to produce enough of a digestive enzyme known as lactase to break down a milk sugar known as lactose—a disaccharide (double sugar), consisting of galactose and glucose.
People who are lactose intolerant are not able to fully digest dairy products. When people who are lactose intolerant do try to ingest dairy, the condition’s symptoms can range from mild to severe and can include diarrhea, abdominal cramps, gas, bloating and nausea.
As we age, the risk of developing lactose intolerance can increase because lactase production decreases. Ethnicity can also be a risk factor: those of African, Asian, Native American or Latin American descent are at higher risk for lactose intolerance. In addition, premature birth or existence of other GI disorders can result in lactose intolerance.
When suffering from lactose intolerance, here are some things people can do to support their gastrointestinal health:
- Take a lactase supplement when consuming dairy products. Many people with lactose intolerance could avoid common symptoms simply by taking a quality digestive enzyme supplement.
- If extremely sensitive, avoid milk products, but don’t forget your calcium. For some people, even a minimal amount of lactose is not tolerable. They are unable to use products that contain any milk-derived components. For these people, getting calcium by other means, such as through supplementation, is necessary for bone health.
- Try probiotics and prebiotics. Probiotics are friendly bacteria that reside naturally in the intestines, helping to promote a healthy digestive system, and may help with digestion of lactose. Prebiotics support the growth of intestinal flora. Great sources of prebiotics and probiotics are fruit, legumes, whole grains, and yogurt.
Gastroesophageal reflux disease (GERD), or acid reflux, is a condition that occurs when gastric acid backs up into the esophagus. The most common symptom is heartburn or regurgitation, which results when the lower esophageal sphincter cannot relax properly to allow food and liquid to flow down into the stomach; the acid then flows back up into the esophagus, causing a burning pain in the chest.
When a person has a history of acid reflux, here are some things they can do support their gastrointestinal health:
- Eat smaller meals. Consumption of a large meal, especially one high in fat, can increase the likelihood of having acid reflux.
- Avoid late-night eating. Lying down after eating, or bending over, can worsen the condition. It is important to keep your head elevated for at least 2 to 3 hours after meals.
- Avoid heartburn triggers. These include fatty or fried foods, caffeine, chocolate, alcohol, and acidic or spicy foods.
- Maintain a healthy weight. Excess weight puts pressure on the abdomen, which can cause acid reflux.
- Elevate the head of your bed, using supports under the legs or a wedge under the head portion of the mattress. This helps gravity work for you instead of against you.
- Avoid stress. A busy schedule can often lead to poor eating habits such as relying mainly on fatty foods, and may affect stomach function.
Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a condition in which the large intestine does not function properly. In some cases, food is forced through the intestines too quickly, causing abdominal cramps, gas, bloating, and diarrhea. In other cases, food passes very slowly, causing stools to become dry and hard, leading to constipation. People who are most at risk for IBS includes the elderly, women and having a family history of IBS. Medications should not be modified without discussion with the person’s physician.
When a person is managing IBS, here are some things that they can do to support their gastrointestinal health:
- Optimize fiber intake. Getting enough fiber in the diet, especially soluble fiber, from fruits and vegetables, can provide support for GI health, leading to better management of IBS.
- Avoid trigger foods. IBS flare-ups can vary from person to person. Response depends to some extent on whether the person has food intolerances (such as lactose) or food allergies.
- Eat small, frequent meals and consume plenty of water.
- Exercise regularly. Increased physical activity can support GI health.
- Try prebiotics and probiotics. Increasing your consumption of probiotics can help promote healthy gut flora and may ease symptoms, but should be used after consultation with a doctor. Great sources of prebiotics and probiotics are fruit, legumes and whole grains, and yogurt, respectively.
Diverticulosis and Diverticulitis
The presence of diverticuli in the colon is a condition known as diverticulosis. The diverticuli are small pouches caused by protrusion of the inner lining of the colon. People who have diverticulosis may be asymptomatic or may have cramping, bloating, and constipation.
When a diverticulum in the digestive system becomes inflamed, perforated, or infected, the condition is referred to as diverticulitis. People with diverticulitis often suffer from symptoms such as abdominal pain, fever, nausea, vomiting, and changes in bowel habits such as diarrhea and constipation.
When a person has diverticulosis or diverticulitis, here are some things they may consider (after consultation with a doctor) to support gastrointestinal health:
- Exercise regularly and lose weight. Obesity and lack of physical activity are both high risk factors for someone with a history of diverticulitis. By adopting a quality weight management and exercise program (as recommended by your doctor), you can help achieve goals of improving your GI health.
- Optimize fiber intake. One of the main causes of diverticular disease is following a low-fiber diet. Making dietary changes to ensure you consume enough fiber daily can be one of the principal ways to avoid having a flare-up, and can be easily achieved by eating plenty of whole fruits and vegetables, and whole grains. If you are not used to having fiber in your diet, start slowly—add a small amount (about 4 grams) to your diet at a time and build up (to about 5 to 6 grams) per serving.
- Drink water throughout the day. Increasing water intake and spacing water intake periodically can help normalize bowel movements. Fiber is very absorbent, and will draw water from your intestinal lining, leading to constipation, unless you consume enough water.
- Magnesium. Getting enough magnesium in your diet such as from leafy green vegetables can be important for helping to attract water into your colon for normalized bowel movements.
Inflammatory Bowel Disease (Crohn’s or ulcerative colitis)
Crohn’s and ulcerative colitis are inflammatory bowel diseases (IBD) with a major auto-immune component that requires consultation with a medical doctor and proper medical treatment. They both cause inflammation in the digestive tract. Crohn’s can affect any part of the digestive tract from the mouth to the anus, usually in patches, whereas ulcerative colitis affects only the lining of the colon.
People with IBD may suffer from symptoms that range from mild to severe that include abdominal pain, diarrhea, blood in stool, low-grade fever, loss of appetite, and weight loss. Those at highest risk are those with a family history of IBD, cigarette smoking, and, possibly, environmental factors.
When a person has had a history of IBD, here are some things they can do to support gastrointestinal health:
- Try prebiotics and probiotics. Studies where people incorporated probiotics and prebiotics into their diets have shown potential advantages in GI health. Great sources of prebiotics and probiotics are fruit, legumes and whole grains, and yogurt, respectively.
- Consume fish oil. Fish oil contains long-chain omega-3 fatty acids that have been shown in studies to support GI health.
Hemorrhoids are collections of arteries and veins under the anal lining that can become swollen, painful, and bleed. They affect about 5 percent of the population in North America. Often they can be managed with diet, but if they do not improve, it is important to see a colorectal surgeon, as not all anal discomfort is from hemorrhoids, and, even if you are suffering from hemorrhoids, other treatments may be indicated.
When a person suffers from swollen hemorrhoids, here are some things they can consider doing to manage symptoms:
- Optimize fiber and water. Consume plenty of fiber (25 to 30 grams of fiber) and water (at least 8 glasses) throughout each day to aid bowel function and regularity, reducing risk of constipation and decreasing stress in the anal area.
- Avoid sitting for long periods or turning the bathroom into a library. Sitting too long puts pressure where it doesn’t need to be – in the veins of the anus.
- Avoid strain on the toilet. Relax and let your natural function work.
Nicole J Kafka, MD, is a board-certified general and colon and rectal surgeon with a private practice in New York City. She received her medical degree from Cornell University and her undergraduate degree, with honors, from Harvard University. She is also a published author in her field, has been interviewed for print publications, and has appeared on radio and television. By night, Dr. Kafka is also an accomplished “Renaissance woman,” entertaining as a trained classical singer in venues ranging from New Jersey bars to Carnegie Hall.