The label of Irritable Bowel Syndrome is very common but does little in the way of helping patients identify triggers for their symptoms. IBS is used to describe symptoms as varied as abdominal pain, gas, bloating, diarrhea and constipation. What saddens me as a physician is that so many of my patients come to me with this label and have never been given the benefit of a thorough medical workup to actually find the cause of their symptoms. The vast majority of my IBS patients do have something that we can identify and treat, leading to more control over digestive symptoms and better quality of life. IBS is not something you need to simply “learn to live with!” You may, in fact, have:
- Poor digestive function due to low enzyme production and stomach acid
- Food allergies or intolerance to protein or sugar/starch
- Infections with parasites, bacteria, or yeast
- Inflammatory bowel disease (Ulcerative colitis, Crohns Disease)
- Other (abdominal migraine, appendicitis, adhesions, etc.)
Over the next few months, I will unpack these items in a series of articles and describe how each of these components can be identified and treated effectively.
Poor Digestive Function
Your body goes to enormous efforts to make stomach acid and enzymes in the pancreas. Stomach acid and enzymes are crucial to breaking food down into nourishing particles, preventing infection, lowering inflammation and keeping critters from running wild in the lower parts of the digestive tract. There are a few tricks to help optimize this process.
The first step is mindful eating. The brain is the first organ that needs to be engaged in your meal. Optimal digestion happens before the first bite goes in your mouth. When we eat at our desks, in the car, in front of the TV or other mindless states, digestion suffers. Take time to enjoy your meal! Stop working, relax, and pay attention to your food. Preparing your meal, appreciating the smells, tasting the ingredients as you go are all important steps in getting your brain engaged in the digestive process. Your brain then tells you pancreas what’s coming and your pancreas makes the appropriate mix of enzymes to digest the meal.
The next step is thorough chewing. You need to chew your food until it is liquid. This gets the saliva all mixed into the bite, which starts the chemical breakdown. Some doctors advise their patients to chew each bite 31 times. When you’re first training yourself to slow down, this can be a helpful trick to get you to start digesting properly. This also helps you pace your meal so that you don’t overeat. If you are not chewing and liquefying your food, there are pieces too big for the lower parts of the digestive tract to break down. The undigested food will then ferment and fuel abnormal bacterial populations, cause gas and bloating, and you will absorb the putrefied by-products. Old-timey Naturopaths call this stuff “morbid matter” in the gut. It’s not nourishing. It’s toxic.
Finally, you should avoid consuming large amounts of liquids, especially iced or cold liquids, with your meal. Diluting the stomach acid and enzymes will hamper digestion. Food will stay in your stomach longer in order to reach sufficient acidification, leading to bloating, discomfort and sometimes reflux. Cold liquids will make your enzymes less effective at breaking food down. This can also lead to undigested material fermenting in the intestines. I tell my patients to drink liquids between meals, either 30 minutes before or an hour after eating. Of course, if there are vitamins or medications that you need to take with your meals, you will need some water to help swallow them. Just don’t overdo it to the point where you are diluting your digestive juices.
If you suspect that you’re not making robust digestive juices, here’s a simple tip: start your meals with apple cider vinegar. Put 1-2 teaspoons in a small amount of water, 2 ounces or so, and drink shortly before your meal. You’ll notice your mouth watering, your tummy rumbling, and other signs that your digestive tract just got a jumpstart. After training yourself with this technique, sometimes you may only need to smell vinegar to get your digestive juices flowing. We can also test your levels of stomach acid and enzymes to see if this is part of your picture.
One of the most common questions I get is about acid-blocking medications like Prilosec or Protonix. These medications are helpful for ulcers, gastritis, or when people have damage to the esophagus caused by chronic reflux. The thing is: they are not supposed to be used for more than a few weeks! Ongoing use of these medications can cause vitamin and mineral deficiencies, bone density problems, and leave you vulnerable to digestive infections. Getting my patients off of these medications and finding other ways to address reflux, gastritis, ulcers and produce appropriate levels of stomach acid is always an early goal of treatment!
Once we have set the stage for good digestion with mindfulness, chewing, optimizing stomach acid and enzyme production, many people’s symptoms resolve! For others, it is often so much easier to recognize patterns and identify individual food triggers for IBS-type symptoms. I look forward to the next posting where I will talk about specific food intolerances. In the meantime, happy chewing!
