Check your medicine cabinet, briefcase, purse, glove compartment, or pocket. How many of these prescription and nonprescription remedies do you own? When heartburn strikes, is your first impulse to pop a pill or chew a mint instead of thinking about what brought the episode on? How much money are you spending on medicine? How much time has your physician spent teaching you that you may not need to take any medication at all?

     I've written this book to show you that common digestive symptoms, such as heartburn (acid indigestion), gas, bloating, diarrhea, constipation, and abdominal pain (stomachaches) can often be relieved through lifestyle changes -- and may not require medicines at all. Over the past thirty years, hundreds of patients have come to me with these symptoms, and, time and again, I have seen that people often prefer or expect a prescription for medicine instead of a recommendation that they change their lifestyle. That's because they want a "quick fix" rather than undergo the lengthy and sometimes difficult process of permanently modifying diet, exercise, and other lifestyle habits they are comfortable with. So one of the first things I have to help them change is their attitude about health. 

Are Digestive Disorders a Necessary Consequence of Today's Life? 

     Far too many people accept heartburn, gas, bloating, diarrhea, constipation, and abdominal pain as normal. They chew rolls of mint-flavored antacid tablets, drink thick chalky elixirs to coat their stomachs, or pop the latest indigestion-relieving wonder drugs as appetizers before downing heavy, spicy, or fattening meals and still consider themselves in relatively good health. I'd like to argue that they are mistaken. 

     Gastrointestinal health -- and indeed, one's overall health -- is influenced by the dynamic, ever-changing interplay of numerous physical, nutritional, psychological, and social factors. These include eating patterns we learned in childhood, or attitudes about food, dining patterns, food choices, stress and anxiety levels, our workplace environments, and the priority we give to regular exercise in our lives. 

     In this chapter, we'll take a look at the symptoms and causes of some of the most common types of gastrointestinal disorders, including irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) that consistently send millions of Americans to the doctor and drugstore. (Note: Gastroesophageal reflux disease is often just referred to as heartburn, because heartburn is the disease's most common symptom. Sometimes the condition is also called "acid indigestion.") 

     A staggering number of Americans -- sixty to seventy million, or one in four -- are affected by gastrointestinal diseases. In fact, heartburn, gas, bloating, diarrhea, and constipation are the most common causes for visits to primary care physicians. I'll explain how each of these digestive tract conditions can be influenced by physical, nutritional, psychological, and social factors, and in the following chapters I'll provide practical tips for combating them.

Factors That Can Affect Your Digestive Tract 

Physical Factors 
     Certain physical characteristics of people who suffer from common GI disorders can affect the disease. For instance, in a person with irritable bowel syndrome, the lining of the intestine is extrasensitive to a variety of stimuli, more so than in other people. So, for example, when the persons abdomen becomes distended (swollen) from eating gas-producing foods like cabbage and broccoli, it may cause tremendous pain and discomfort, whereas in a person who does not have the sensitivity, the same amount of distention will not cause any significant pain or discomfort. 

     Another physical factor that causes a digestive condition is infection with a bacteria called H. pylori, which causes some people to suffer from peptic ulcers. Still another is a weakened muscle called the lower esophageal sphincter (or LES), located between the stomach and the esophagus -- the food pipe. This weakened muscle allows stomach acid to back up toward the throat, causing heartburn or acid indigestion. Even gravity contributes to heartburn in many people who lie down or recline too soon after eating a large meal. 

The Effects of Smoking 
     Smoking produces both overt and hidden deleterious effects on the gastrointestinal tract. When you inhale smoke, a lot of it gets into your gastrointestinal tract. This will manifest itself as a sensation of gassiness, bloating, rumbling, gurgling, and even cramping. More importantly, smoking can be associated with serious injury to the gastrointestinal tract. For example, nicotine stimulates acid production, therefore, it promotes acid reflux, as well as worsening peptic ulcer disease. Smoking is clearly associated with an increased risk of cancer of the esophagus and cancer of the stomach. The mechanism by which smoking invites the development of cancer isn't completely understood, but the association remains strong. 

     A fifty-two-year-old businessman came into my office with a long list of gastrointestinal complaints, including belching, bloating, rumbling and gurgling, abdominal cramping, and recently difficulty swallowing. He'd had these symptoms for years, but he was always "too busy" to do anything about them. Accordingly, he had never taken any acid-reducing drugs, made any lifestyle changes, or even been evaluated. His symptoms were characteristic of irritable bowel syndrome, which had been aggravated by the ingestion of smoke over the years. His smoking two to three packs per day was clearly worsening his underlying condition. However, his trouble swallowing suggested that he had developed either an inflammatory stricture in the esophagus or esophageal cancer. Accordingly, he underwent upper endoscopy and our worst concerns were realized. He, indeed, had cancer of the lower third of the esophagus. He underwent extensive surgery, but survived only nine months. He was a victim of his lifestyle. 

Nutritional Factors 
     Certain food choices can trigger or worsen gastrointestinal disorders. Obviously, poor dietary choices can lead to excess weight gain, which in turn causes a multitude of health problems. It's amazing to note that we are seeing an increase in dietary-related medical conditions as our society becomes more affluent. Even though there are more wholesome foods available today than perhaps ever before, we are making poor food choices. For example, while our grandparents ate a relatively well-balanced diet of grains and vegetables with little meat and occasional sweets, today's average American diet is far too high in fats, protein, sugar, and salt -- and it's short-changed on complex carbohydrates. One reason for this epidemic of poor eating habits may be the availability of fast-food restaurants that offer taste-tempting, filling foods -- like hamburgers, fried chicken, and burritos -- for moderate prices. Many people who are working longer hours find it advantageous to stop at these fast-food restaurants or delis and pick up fat-laden, ready to-eat dinners on their way home from work. 

     For many people with digestive disorders, the most obvious but least-followed nonmedical therapy is following a proper diet. However, reworking a diet to alleviate or eliminate a GI condition requires more than the elimination of junk food. Even healthy foods can aggravate the systems of those with heartburn, gas, bloating, constipation, diarrhea, or stomach pain. For example, cabbage, broccoli, and beans are healthful, nutritious foods for most people, but they cannot be tolerated by people who suffer from gas and bloating because these foods produce gas in the digestive tract. In the same way, milk and milk products are healthful sources of protein and calcium for most people, but they can aggravate gastrointestinal symptoms in those who are lactose-intolerant. 

     The problem is that there is no single diet that will work well for all people with digestive problems. I can't just hand my patients a preprinted list of foods to eat and foods to avoid. Because each individual is unique, we must examine what foods he or she has been eating and how those foods have affected his or her symptoms. 

     In chapter 3, I'll outline a game plan to get your diet back in proper balance and help you uncover which food choices are apt to wreak havoc on your particular digestive tract. I'll show you how to keep a journal and use it to determine which foods are causing your digestive symptoms. If you're like many of my patients, you'll be surprised to learn that some foods you thought were causing you trouble aren't really the culprits after all! Then, I'll show you how to use the information you gather from your food journal to help you create your own personal food guide pyramid -- a personally customized version of the original USDA Food Guide Pyramid -- that will help you eat a balanced diet and avoid your unique set of GI symptoms. I'll also give you tips for gradually starting to make changes to your diet in ways that will help you change your eating habits permanently -- without being unhappy about it. 

Psychological and Social Factors 
     In many people, especially those with irritable bowel syndrome, stress and anxiety can influence GI health as strongly as food choices. Your self-esteem and general outlook can also affect GI health. Further, our social lives are awash with alcohol and irregular dining habits, which spell bad news for GI health. In this book we'll dig deep into how social conditions influence behavior, which in turn can have a profoundly negative effect on the digestive system. 

     Over the past thirty years, I have observed broad changes in my patients' dietary and lifestyle habits. Nearly all of my married patients are part of dual-income families, in which both partners work to make ends meet. My patients generally work longer hours, bring work home, and take fewer vacations. Cellular phones keep them connected to the office day and night. To relax, they self-medicate with "comfort foods," alcohol, and the television remote control. Despite warnings posted on cigarette packs about the increased risk of health problems connected to smoking, many still light up. One of the most striking changes I have seen is how much less exercise my patients get today compared with a couple of generations ago. As machines and computers have made our daily lives easier, we humans no longer have to perform many physical tasks -- like washing clothes with a scrub board or tilling the soil to grow food for dinner -- chores that gave our ancestors a good workout. More and more of us have sedentary jobs. We ride to and from work in automobiles -- parking as close to the building as possible -- or take public transportation, take elevators instead of climbing stairs, and then sit most of the day engaging in little physical activity other than typing on a keyboard or lifting a telephone receiver. While we once got up from our chairs and walked down the hall to talk with coworkers, we now send e-mail messages. Thanks to modern conveniences, from garage-door openers to drive-through car washes to remote TV and stereo controls, physical activity has often all but disappeared from our daily lives. 

Copyright © 2000 The Philip Lief Group, Inc., and Gary Gitnick, M.D.