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Indigestion Indigestion: Be Good to Your Gut-Control Diet & Stress
by Pat Baird, M.A., R.D.

We're all familiar with the occasional upset stomach and indigestion after eating a meal. What most of us then do is reach for the antacid bottle in the medicine cabinet. When antacids and other over-the-counter remedies don't relieve the discomfort, or when these stomach complaints and accompanying symptoms-such as bloating and upper abdominal distress or even pain-worsen or occur more frequently, people turn to their doctors for help. About five percent of all visits to family physicians and other primary care practitioners are for indigestion, as are up to one-third of referrals to gastroenterologists.
Doctors have a name for indigestion: dyspepsia, which merely means bad digestion. People may not have all the symptoms of dyspepsia described here, but by and large they know when they have it.
Individuals with indigestion typically will complain of some combination of heartburn, regurgitation, belching, bloating, feeling full after eating even a small meal, gassiness, nausea, and perhaps vomiting. Often, symptoms increase in frequency, and the discomfort escalates. When indigestion become chronic, it is a source of constant pain in the middle-to-upper part of the stomach.
These symptoms may resemble the complaints of a person with gastroesophageal reflux disease (GERD), and it is true that the two conditions are very similar. Heartburn and regurgitation, in particular, are common to both. Most symptoms clearly are related to eating. In addition, impairment of GI motility-the underlying cause of GERD-appears to be frequent in people with dyspepsia as well.
Nevertheless, dyspepsia is a distinct condition from GERD. In many individuals, GERD may be the cause of the dyspepsia, but other diseases also give rise to the same symptoms. These other possible diagnoses include peptic ulcers, gallstones, pancreatic disease, and, in rare instances, stomach cancer, to name a few. More often than not, though, people have unexplained dyspepsia. That is, there are no abnormalities on physical examination, and the series of tests ordered by the doctor come back negative.
When diagnostic tests identify the underlying cause, the dyspepsia is said to have an organic origin. When there is no obvious cause, the dyspepsia is functional. Functional dyspepsia is made more difficult to recognize by the presence, in more than one in three people, of chronic lower abdominal pain and changes in bowel habits.
Whether or not someone's indigestion is caused by GERD, motility may still be an important contributing factor. In addition, diet has long been implicated in dyspepsia. For example, foods rich in fat stay in the stomach longer and may lead to delayed stomach emptying. Some experts believe that emotional stress may result in dyspepsia, either directly or indirectly, by affecting stomach motility or by aggravating an irritable bowel.

What to Do about It
In patients with organic dyspepsia, the aim is to treat the underlying cause of the symptoms. With functional dyspepsia, the physician may recommend a therapeutic trail of medication. In both groups of patients, a few relatively simple dietary modifications may be effective. You may also want to see a registered dietitian for personalized nutrition-counseling sessions. These meetings are especially useful in helping to get a clear picture of what you're currently eating. The dietitian will probably ask you to take along a record of what you've eaten for the past three days. With that information in hand, he or she will help you to identify particular patterns or foods that are related to your indigestion.

Diet
If you suspect that your indigestion is caused by eating certain foods, a food diary in which you list every food and beverage consumed throughout the day is the best aid to help you establish a possible link. Be sure to write down everything.
Big family dinners, holiday parties, and social gatherings are all too often followed by indigestion. Smaller, more frequent meals are helpful for many people. You'll also probably feel more comfortable if you reduce or eliminate your intake of caffeine and alcohol. Remember that even decaffeinated beverages can cause indigestion in some people.
Specific foods that seem to provoke indigestion include orange juice, tomato juice, tomatoes, and radishes. Few people with indigestion complain of spices being a problem, but if your food diary shows a routine upset after you eat a certain herb or spice, by all means, eliminate it. Though some people think they are reacting to spicy sauces, it is more likely the tomato base of the sauce that is the problem-not the spice itself. A little trial and error on your part, along with notes in your food diary, will help you determine what is troublesome for you.
Keeping the fat content of meals and snacks low is a good idea. Remember that fat tends to slow down the rate at which the stomach empties. The less fat the stomach has to handle, the less time the food will be there. And the more quickly it moves to the next stage of digestion, the less likely it is to create a problem. There's no doubt that if stomach motility is slow, or if you eat large, fatty meals washed down with alcohol and coffee, indigestion is bound to be a problem. You might try eating less fried and greasy foods like fried chicken, french fries, heavy sauces, and gravy. Salad dressings and large portions of cheese and nuts should also be reduced. You may not have to eliminate any food at all. Just eating less of it could be the solution.

Stress
Stress figures prominently in any discussion of indigestion. However, its exact role can be more elusive than that of dietary factors. For example, it becomes clear after a while that every time fried food is eaten, indigestion occurs. But the connection between a stressful work situation, for instance, and the incidence of belching or bloating is far less obvious. That's because we're often unaware that stress is present, or of the possible effects it may have.
One way to track stress is through your food diary. When making notes of what you're eating, also consider entering information such as where you were and whom you were with at the time. Note how you were feeling and what was happening in your life. If you are able to connect a particular event with stress (and the ensuing indigestion), the cause may be stress-related. In that case, see what you can do to deal with the person or circumstance causing the stress. Simply identifying the source may help you to eliminate it.
Habits such as not chewing thoroughly or eating too quickly can contribute to indigestion. Both of these habits may be stress reactions. Simple as it may sound, try to eat in a relaxed atmosphere. Of course, that's the tricky part. In all probability, to do that, you're going to have to adjust your schedule a bit-or the schedule of your family—to make things less hectic during mealtimes. When you do, you'll find it's well worth the effort.

Other Suggestions
Most sufferers of dyspepsia will have tried antacids, without long-term success, before paying their physician a visit. Recently, certain medications called histamine-2 (or H2)-blockers-cimetidine (Tagamet®) and famotidine (Pepcid ®)-became available in over-the-counter preparations to treat acid indigestion at lower-than-prescription dosages.
Experience tells us that not all drugs used to relieve dyspepsia will work for all individuals. Nevertheless, some people do feel better, for instance, with H2-blockers at prescription strengths. Success has also been reported with a class of medications called the prokinetics. These latter drugs-an example is cisapride (Propulsid®)-have beneficial effects on the rate of stomach emptying.
Aspirin, aspirin-containing products, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) are definitely not recommended to relieve any type of indigestion or related stomach pain. In fact, these drugs, which many older people take for arthritis and other conditions, can irritate the lining of the stomach and cause injury. An antacid preparation (Mylanta®) may be particularly helpful in dyspepsia caused by NSAID use.

From Be Good to Your Gut, by Pat Baird, M.A., R.D. © 1996 by Blackwell Science, Inc. Excerpted with permission by Blackwell Science, Inc. Available in local bookstores or by calling 800-215-1000. $14.95.



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