LONDON — Special foods are among the pleasures of holiday celebrations. On the negative side, for people with digestive diseases or those who overindulge, holiday feasting can quickly produce the food version of a hangover. James East, M.D., a gastroenterologist at Mayo Clinic Healthcare in London, explains why this sometimes happens and how we can enjoy the menu while also making holidays happy for our digestive systems.

Why indigestion and heartburn happen

Indigestion, or an upset stomach, can be caused by overeating; eating fatty, greasy or spicy foods; consuming too much caffeine, chocolate, alcohol or carbonated beverages; smoking; anxiety and certain medications, such as some antibiotics, pain relievers and iron supplements.

It also can be a symptom of an underlying digestive disease, such as pancreatitis, celiac disease, irritable bowel syndrome or gastritis.

While indigestion involves discomfort in the upper abdomen, heartburn is a pain in the chest behind the breastbone.

“Heartburn is caused by acidic stomach content moving into the oesophagus, or gullet, which is much less resistant to acid,” Dr. East says. “This results in irritation and damage to the lining of the oesophagus, literally a burn, that causes pain.”

Like indigestion, heartburn can be caused by large, fatty, greasy or spicy meals, chocolate, alcohol, carbonated beverages and caffeine. But the list of foods linked to heartburn is longer: Onions, citrus fruits, tomato-based foods and peppermint are among the additional culprits.

Chronic heartburn is known as gastroesophageal reflux disease.

“The ring of muscle at the bottom of the gullet usually squeezes tightly except when we swallow food; however it can get weaker with age, or disrupted if patients develop a hiatal hernia,” Dr. East explains. “Conditions that slow gastric emptying, such as gastroparesis, or increase pressure within the abdomen, such as obesity or pregnancy, also can make reflux more likely.”

Other ways food can irritate the digestive system

Holiday foods that seem benign can pose hazards for those with digestive diseases, Dr. East says.

For example, dairy products, alcohol, caffeine and large meals can make people with inflammatory bowel disease feel worse.

Sticky foods such as peanut butter and caramel, thin liquids such as coffee and juice, and alcohol, caffeine or large meals can prove difficult for people with swallowing disorders, known as dysphagia. A menu lacking fiber such as those heavy in processed foods, meat, dairy products can make chronic constipation worse.

Avoiding raw fruits and vegetables, carbonated drinks, alcohol and large meals is recommended for people with gastroparesis, a motility or food movement disease that slows or stops the stomach’s ability to move food through the digestive tract.

Preventing digestive discomfort

“Lower-fat food options are helpful for many digestive diseases, as are nonalcoholic beverages,” Dr. East says. “Decaffeinated beverages are helpful for some patients, as is a reasonable level of portion control so that guests don’t feel pressured into overeating.”

Taking antacids or even acid suppressing drugs, such as omeprazole, preemptively can reduce symptoms but should not be an excuse to overindulge, he says: Although these medications reduce acid, they do not help with the volume or regurgitation component of reflux,  so overeating can still lead to uncomfortable symptoms.

“Moderation in both food and alcohol and enjoying the range of dishes available from your host is a better strategy than additional medication,” Dr. East says.

Taking steps to cope with anxiety and stress is also important.

“Anxiety and stress play a major role in gastroenterological symptoms, especially irritable bowel syndrome, which is a disorder of the brain-gut axis,” Dr. East says. “Our brains and gut have very dense neural connections and being stressed or anxious can lead to gut nerves being oversensitive where they fire off pain signals, such as cramping or bloating, at much lower levels of stimulation than would normal be required, known as visceral hypersensitivity.”

Techniques to reduce stress and anxiety such as mindfulness, cognitive behavioral therapy or hypnotherapy can help, he says. Physical positioning also plays a role.

“Classical triggers for reflux include a large fatty meal late in the day, with alcohol, and then lying down flat,” Dr. East says. “To avoid heartburn, we should do the opposite and have our main meal in the middle of the day, not eat within three hours of bedtime, avoid fatty foods, moderate alcohol intake and consider raising the head of the bed.”

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About Mayo Clinic Healthcare
Mayo Clinic Healthcare, located in London, is a wholly owned subsidiary of Mayo Clinic, a not-for-profit academic medical center. Mayo Clinic in the United States is ranked No. 1 in more specialties than any other hospital by U.S. News & World Report for a reason: quality of care. Mayo Clinic Healthcare is the United Kingdom’s front door to that unparalleled experience. Visit Mayo Clinic Healthcare for more information.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. For information on COVID-19, including Mayo Clinic’s Coronavirus Map tracking tool, which has 14-day forecasting on COVID-19 trends, visit the Mayo Clinic COVID-19 Resource Center.

Media contact:

• Sharon Theimer, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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DEAR MAYO CLINIC: I experience constipation almost weekly, and eating bran flakes every day isn’t helping. Are fiber supplements safe to use regularly and long term? Is there anything else I can do? I’m a 53-year-old woman and otherwise in excellent health.

ANSWER: When consumed at recommended levels, dietary fiber is widely recognized to have health benefits, including relief of constipation. Adult women 50 and younger should consume at least 25 grams of fiber a day. Women 51 and older should have at least 21 grams a day. Adult men need at least 38 grams of fiber a day if they are younger than 50 and at least 30 grams of fiber a day if they are 51 and older. Ninety percent of the U.S. population consumes far below those recommendations, averaging only 15 grams of daily fiber.

Fiber-rich foods include fruits, vegetables, whole grains and legumes. Many cereals, such as bran flakes, are good sources of fiber. Although fiber supplements can fill the daily fiber gap, they usually have only one type of fiber, rather than a variety of fibers and micronutrients, and they may not provide all the health benefits associated with fiber in food. Therefore, boost your fiber intake in your diet first by eating a wide variety of high-fiber foods.

If you still can’t get enough fiber to meet the daily recommendation, consider using a supplement. But keep in mind, not all fibers provide laxative effects. Some, unfortunately, can even cause constipation.

Fibers can be classified as soluble versus insoluble, fermentable versus unfermentable and coarse versus fine. In general, fermentable fibers may increase flatulence, with no effect in providing relief of constipation. Finely ground wheat bran and solid/fermented wheat dextran have been shown to worsen constipation. Coarse wheat and psylium can increase stool water content and fecal mass, and can be used to alleviate constipation.

Before taking a fiber supplement, ask your health care provider or pharmacist to review your medications. Fiber supplements can decrease the absorption of certain medications, including drugs that treat thyroid disorders, depression, diabetes, high cholesterol, seizures and various heart ailments. Even common medications, such as aspirin, ibuprofen and penicillin, can be affected by an increase in fiber. You may take your medications one hour before or two hours after eating fiber to minimize the interaction.

Some fiber supplements may not be appropriate for people with certain medical conditions. For example, if you have celiac disease, you may need to stay away from fiber products derived from wheat. If you have diabetes, you may need to use a flavorless formula to avoid extra sugar. Consult your health care provider for guidance about the appropriate fiber supplement.

Go slow as you begin fiber therapy. Fiber supplements may cause abdominal bloating, cramping and flatulence, especially if you start at a high dose. Begin with a low dose, gradually increasing the amount of fiber. Don’t add more than 50 grams of fiber in a supplement per day, as that may affect how your body absorbs nutrients. Your health care provider can help you determine what’s right for you.

Drinking plenty of water and exercising regularly can ease constipation, too. You also may want to consider nonfiber products, such as stool softeners, stimulant medications that cause your intestines to contract, enemas or suppositories.

If increasing fiber doesn’t improve your symptoms, see your health care provider. Constipation can be a symptom of various underlying medical disorders, such as pelvic floor muscle dysfunction, slow gastrointestinal motility, anatomical abnormalities or endocrine dysfunction, that may require different treatment. — Dr. Yan Bi, Gastroenterology, Mayo Clinic, Jacksonville, Florida

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Related Articles 

• Mayo Clinic Q and A: Getting adequate amount of fiber has several health benefits published 1/28/21
• Mayo Clinic Q and A: Dealing with chronic constipation published 8/2/19

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DEAR MAYO CLINIC: My doctor is recommending a trial of a gluten-free diet to see if my digestive symptoms improve. Can I still get enough fiber without eating bread and bran flakes?

ANSWER: It is possible to get enough fiber, even without eating foods that you may typically associate with good sources of fiber, such as bran flakes and bread. And that's important because getting an adequate amount of fiber each day has several health benefits.

Fiber is best known for preventing and relieving constipation by helping to bulk up and soften stool, making it easier to pass. It also may lower the risk of hemorrhoids, pouches in the colon (diverticulosis) and colon cancer. A high-fiber diet also may improve cholesterol levels, control blood sugar and help you maintain a healthy weight.

Gluten is a protein found in grains such as wheat, barley and rye. In the U.S., these grains are a major source of dietary fiber. A switch away from consuming them could eliminate a major source of fiber in your diet.

However, there are a wide variety of high-fiber foods, including many grains, that are naturally gluten-free. These foods include vegetables and fruits of all types; whole grains that do not contain gluten, such as brown rice, quinoa, buckwheat, corn, popcorn and oats that are labeled gluten-free; beans, peas and lentils; and nuts and seeds, preferably raw or roasted and with minimal salt.

Other food products that are labeled gluten-free, such as breads, pancake mixes, snack bars or pasta, also can contribute to fiber intake in varying amounts.

The amount of fiber recommended for men and women varies, and is based on your age. Men younger than age 50 should aim for 38 grams of fiber every day. Women younger than age 50 need 25 grams of fiber per day. For people 51 and older, less fiber is necessary: 30 grams of daily fiber for men and 21 grams for women.

Getting enough fiber in your gluten-free diet may take some adjusting, but it's possible that you'll be eating healthier than before as you incorporate a wider variety of fiber-rich foods into your diet. In addition, by cutting out less healthy gluten-containing foods — particularly low-fiber, processed foods, such as baked goods — you may even find that your fiber intake improves. (adapted from Mayo Clinic Health Letter) — Dr. Kevin Ruff, Gastroenterology, Mayo Clinic, Scottsdale, Arizona

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Common causes of chronic constipation

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DEAR MAYO CLINIC: Can irritable bowel syndrome be managed without medication, or is it typical that someone with this condition will need medication to control symptoms?

ANSWER: Medications can be used to treat irritable bowel syndrome, but not everyone who has this disorder needs medication. For some people, particularly those with mild symptoms, lifestyle adjustments, such as diet modification, stress management and regular exercise, are enough to control symptoms. For moderate to severe symptoms, a combination of lifestyle changes and medication may be necessary to manage irritable bowel syndrome.

Irritable bowel syndrome affects the large and sometimes small intestines. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food through the digestive tract. When you have irritable bowel syndrome, those contractions may be stronger or more noticeable than normal. That can lead to abdominal cramping and pain as food, gas or stool passes through the intestines. Irritable bowel syndrome also is associated with bowel irregularity, such as diarrhea or constipation. Other symptoms can include gas and bloating.

In those diagnosed with irritable bowel syndrome, it’s important to be aware that some abdominal issues are not associated with this disorder and could signal another underlying problem. In particular, these symptoms require prompt medical attention: blood in the stool, unexplained or rapid weight loss, unrelenting or severe abdominal pain, unexplained vomiting, significant pain with or difficulty swallowing, or an abdominal mass or lump.

Irritable bowel syndrome is a chronic condition, and symptoms tend to come and go over time. There’s no cure, but symptoms often can be eased with diet, lifestyle and stress management.

More than 60% of people who have irritable bowel syndrome say their symptoms are connected to food in some way. However, because symptoms vary significantly from one person to another, it’s difficult to give specific dietary advice that works for everyone with this disorder.

In general, though, eating high-fiber foods and drinking plenty of fluids are beneficial for many people with irritable bowel syndrome. Avoid foods and beverages that contribute to gas and bloating, including carbonated and alcoholic beverages; caffeine; raw fruit; and vegetables such as cabbage, broccoli and cauliflower. Reducing or eliminating gluten may ease diarrhea that’s related to irritable bowel syndrome.

Research has shown that certain carbohydrates known as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) can lead to abdominal pain, bloating and gas in people with irritable bowel syndrome. These are found in certain fruits and vegetables; wheat; rye; legumes; foods that contain lactose, such as milk, cheese and yogurt; and artificial sweeteners.

Following a diet low in FODMAPs can ease symptoms of irritable bowel syndrome. But because so many foods contain these compounds, it can be difficult for patients to create such a diet on their own. Finding a dietitian familiar with irritable bowel syndrome can help. A dietitian can review a patient’s symptoms and dietary needs, discuss recommended dietary changes, and develop an individualized food plan to ease symptoms.

Stress also affects irritable bowel syndrome, with episodes of higher stress associated with an increase in symptoms. Using stress reduction techniques and participating in activities that relieve stress, such as yoga and meditation, may decrease stress-related flare-ups. Working with a therapist or counselor experienced in stress management, mindfulness and behavior modification also may help those with irritable bowel syndrome better control stress and ease symptoms.

Regular exercise is recommended for people who have irritable bowel syndrome. Daily physical activity relieves stress, stimulates normal contractions of the intestines and promotes overall wellness.

If lifestyle changes alone aren’t enough to keep irritable bowel syndrome from disrupting daily life, talk to your health care provider about medication options. A wide variety of prescription and nonprescription medications are available to treat irritable bowel syndrome. — Dr. Robert Kraichely, Gastroenterology, Mayo Clinic, Rochester, Minnesota

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Related Articles

• Mayo Clinic Radio: Irritable bowel syndrome published 4/4/19
• Pregabalin may lessen pain from irritable bowel syndrome, Mayo Clinic study finds published 10/17/16
• Home Remedies: Irritable bowel syndrome published 10/14/16

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Although heart disease often may be thought of as a problem for men, heart disease is the most common cause of death for both women and men in the U.S., according to the American Heart Association. On the Mayo Clinic Radio podcast, Dr. Sharonne Hayes, a cardiologist at Mayo Clinic, discusses women’s heart health through the life span. Also on the podcast, Dr. Bret Petersen, a gastroenterologist at Mayo Clinic, explains gallbladder disease. And Dr. Jean Fox, a gastroenterologist at Mayo Clinic, offers tips for preventing the common problem of constipation.

The post #MayoClinicRadio podcast: 10/27/18 appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Sharonne Hayes, a cardiologist at Mayo Clinic, will discuss women’s heart health through the life span. Also on the program, Dr. Bret Petersen, a gastroenterologist at Mayo Clinic, will explain gallbladder disease. And Dr. Jean Fox, a gastroenterologist at Mayo Clinic, will offer tips for preventing the common problem of constipation.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Pregnancy, menopause and heart health appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Sharonne Hayes, a cardiologist at Mayo Clinic, will discuss women’s heart health through the life span. Also on the program, Dr. Bret Petersen, a gastroenterologist at Mayo Clinic, will explain gallbladder disease. And Dr. Jean Fox, a gastroenterologist at Mayo Clinic, will offer tips for preventing the common problem of constipation.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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ANSWER: Diverticulosis is a common condition that usually doesn’t cause any symptoms. But, in some cases, diverticulosis may develop into a more serious disorder known as diverticulitis. Research has shown that eating a high-fiber diet may play a role in preventing diverticulitis in people with diverticulosis. Other diet and lifestyle changes can make a difference, too.

Diverticulosis affects the gastrointestinal tract. Small sacs, called diverticula, bulge out of the colon wall. This condition is common as people age. Estimates are that about half of the U.S. population over 50 has diverticulosis. Most people have it by the time they are 80. Once diverticula form, they do not go away.

Diverticulosis by itself typically isn’t noticeable. Rarely, diverticula may bleed, causing blood in the stool. Diverticulosis often is found during a routine colonoscopy or on an imaging exam, such as a CT scan that’s done for another reason. You can have diverticulosis for years without any complications or problems. If one or more of the diverticula become inflamed or infected, however, that condition is diverticulitis.

While diverticulosis doesn’t lead to discomfort, diverticulitis can be painful. Common symptoms include significant abdominal pain, as well as fever, constipation or diarrhea, nausea, and fatigue.

To help prevent diverticulitis, eat a high-fiber diet with lot of fruits, vegetables and whole grains. This type of diet softens waste and helps it pass more quickly through your colon. That reduces pressure within your digestive tract and may reduce the risk of diverticula becoming inflamed. Studies also have found that limiting the amount of red meat in your diet, particularly unprocessed red meat, may decrease the risk of developing diverticulitis.

In the past, people with diverticulosis were told to avoid nuts, seeds and popcorn. It was thought that these foods could lodge in diverticula and cause inflammation. But there’s no scientific evidence that these foods cause diverticulitis, and there is no need for you to stop eating them.

In addition to modifying your diet, there are other steps you can take to lower your risk of diverticulitis. Maintain a healthy weight and exercise regularly. People who are overweight are at an increased risk for diverticulitis. People who smoke also are more likely to develop the disorder than people who don’t smoke. If you smoke, now would be an excellent time to quit.

High blood pressure and high cholesterol can contribute to an increased risk of developing diverticulitis. If you have either of these conditions, talk to your health care provider about ways to keep them under control.

Regular use of nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen or aspirin, may raise your risk of diverticulitis. But if you currently take an NSAID for another medical condition, don’t stop taking it until you talk with your health care provider about what’s right for you.

If you notice any symptoms of diverticulitis, contact your health care provider right away. In many cases, diverticulitis can be treated with over-the-counter pain relievers and antibiotics. You also may need to stick to a liquid diet for several days while your colon heals. — Dr. Kellie Mathis, Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

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ROCHESTER, Minn. — Genetically engineered bacteria are showing promise as a new treatment for constipation, researchers at the Mayo Clinic Center for Individualized Medicine have discovered in a mouse study. The finding is significant in part because there are few approved constipation remedies on the market. The research is published in Cell Host & Microbe.

Because the community of bacteria found within the stomach and intestines — known as the gut microbiome — is unique to each person, generic probiotics don’t work for everyone. Probiotics are live bacteria that can aid in digestion.

The genetically engineered bacteria in the Mayo study produced large amounts of the chemical tryptamine. This chemical helps food pass through the intestines with potentially less risk of side effects than other constipation drugs.

“Tryptamine is similar to the chemical serotonin, which is produced in our gut," says lead author Purna. Kashyap, M.B.B.S., associate director of the Center for Individualized Medicine Microbiome Program. "In this study, we found tryptamine can activate a receptor in the mouse gut that normally responds to serotonin, causing increased secretion of fluid from the lining of the colon. Bacteria can direct the colon to secrete water via tryptamine acting on a host receptor in mice. This accelerates the movement of food through the digestive system."

For decades, people with constipation have often been advised to change their diets, but that hasn’t worked universally because everyone is unique in terms of their genes and microbiome, Dr. Kashyap says.

“These synthetic bacteria spur transit of food through the digestive system without messing with diet and microbes,” he says.

Bacterially produced tryptamine quickly degrades in the intestine and does not appear to increase in the bloodstream. That reduces the risk of side effects outside the gastrointestinal tract. Other drugs for constipation can affect different areas of the body, including the heart.

“Our goal with this research is to find treatments that act only in the GI tract without creating problems in other parts of the body,” Dr. Kashyap says.

The findings are also important to the study of gastrointestinal disorders such as irritable bowel syndrome.

Additional preclinical studies will be done to verify the findings: A clinical trial with humans is likely at least three years away, Dr. Kashyap says.

Study funding comes from the Mayo Clinic Center for Individualized Medicine, Mayo Clinic Department of Gastroenterology and Hepatology, and National Institutes of Health grants DK100638, DK111850, DK114007 (PCK), NIDDK K23 103911 (MG), as well as the Global Probiotic Council.

Yogesh Bhattarai, Ph.D., from Mayo Clinic is an additional author on this study.

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About Center for Individualized Medicine
Mayo Clinic Center for Individualized Medicine discovers, translates and applies new findings in genomic research into individualized medicine products and services for patients everywhere. Learn more on the Mayo Clinic Center for Individualized Medicine website.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network.

Media Contact:

• Susan Buckles, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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