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Get Relief from Digestive Woes
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For people with diabetes, gastroparesis is not the only source of potential digestive problems
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By Stacey Colino
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Diabetes Focus Fourth Quarter 2006
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It’s easy to forget about your digestive system when things are going well. But when gas, cramps, heartburn or diarrhea kick in, it can feel as though digestive distress has taken over your entire body, if not your life. Approximately 70 million people in the United States suffer from some kind of digestive disorder, at an annual cost of $107 billion in medical expenses and absences from work.
What many people don’t realize is you can take steps to avoid digestive problems through the lifestyle choices you make on a daily basis. To keep your gastrointestinal (GI) tract healthy and content:
• Consume a balanced, varied diet that contains lots of fruits, vegetables, whole grains and non-caffeinated fluids.
• Limit your intake of fat and of sugary foods, and avoid large meals or eating late at night.
• Eat slowly and chew your food thoroughly.
• “Maintain a healthy weight and exercise regularly to promote movement through the GI tract,” advises Cindy M. Yoshida, M.D., a gastroenterologist in Charlottesville, VA, and author of No More Digestive Problems.
• Take time on a daily basis to manage or relieve your stress—with yoga, deep breathing, or whatever technique works for you—because stress may contribute to or aggravate digestive problems.
We have all felt like our digestive system has a mind of its own. It sends us strong cravings for particular foods, guides us to follow our gut instincts about a decision, or lets us know when we are anxious or stressed, even before our mind has become aware of how we are feeling.
“There is essentially a brain in the gut,” says Michael D. Gershon, M.D., a professor of pathology and cell biology at Columbia University in New York City and author of The Second Brain: A Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestine. “It’s not a thinking, emoting kind of brain,” but the small intestine is home to the enteric nervous system.
The digestive tract is the only organ system in the body that has its very own brain—and it’s a large one, containing more than 100 million neurons, Dr. Gershon notes. “It governs itself, but it also sends messages to other organs such as the gallbladder and pancreas and it talks back to the brain.” These gut-to-brain signals are sometimes in the form of symptoms such as nausea, but they can also be transmitted in subliminal ways.
“The gut can influence the emotional centers of the brain because it sends messages that can alter mood and change personality,” Dr. Gershon says. In fact, 95 percent of the body’s serotonin—the neurotransmitter that plays a role in mood—is in the gut, and the gut uses it to send messages to the brain in your head. This two-way transmission of information is critical for survival; after all, it can stop you from eating something that can make you sick or perhaps even kill you. But this communication can also be torturous, as anyone who suffers from chronic heartburn or irritable bowel syndrome knows. “The gut is not an organ system from which you want frequent progress reports,” Dr. Gershon says. “You want it to function in deep, deep background.”
A motility disorder, gastroparesis causes delayed emptying of food from the stomach into the intestinal tract, which can lead to feelings of early fullness and bloating, as well as heartburn, nausea and vomiting. It’s commonly associated with type 1 or type 2 diabetes because chronically high blood sugar over many years can damage nerves throughout the body; in the case of gastroparesis, poor blood sugar control can damage the vagus nerve, which helps orchestrate the complex connections in the digestive tract and affects the wavelike movements that propel digested food through the GI tract. “As a result, the stomach doesn’t empty very well,” Dr. Yoshida notes. Complicating matters is the fact that when food lingers too long in the stomach it can become fermented, which can cause bacterial overgrowth in the small intestine. “This can cause problems with the absorption of foods that can lead to weight loss and metabolic problems such as dehydration and electrolyte imbalances,” she explains.
In addition to those with diabetes, gastroparesis can also affect people who have kidney problems, who take medications (such as painkillers or antianxiety drugs) that slow gastric emptying, or who have suffered a complication from abdominal surgery. It can also happen for mysterious reasons (in which case doctors refer to it as idiopathic gastroparesis). “You can also have transient gastroparesis after a viral infection such as gastroenteritis, in which case it gets better over time,” notes Prabhakar Swaroop, M.D., an assistant professor of gastroenterology at the St. Louis University School of Medicine.
Whatever the underlying cause may be, the condition is typically diagnosed with a gastric-emptying scan to see how quickly food passes through. To treat the condition, dietary adjustments are usually in order: Consuming smaller, more frequent meals that are low in fat and fiber can help with both gastric emptying and the feelings of fullness that often haunt people with gastroparesis. It can also help to have liquid meals—such as soups or pureed foods—which typically pass through the stomach more easily and speedily. Keeping tight control of blood sugar levels can also improve symptoms.
A few different drugs—including promotility agents and antibiotics—can be used to treat gastroparesis. In an emerging treatment, Botox® has been found to relax the muscle that lies between the stomach and small intestine, thereby allowing the stomach to release food more readily; the results are temporary. In another new development, a gastric pacemaker has been found to help. The device is surgically implanted on the stomach, where it provides electrical impulses that “help mimic the normal movements of the stomach, causing it to empty faster,” explains Dr. Swaroop. A recent study at the University of Memphis in Tennessee found that electrical stimulation decreased symptoms of nausea and vomiting and improved the rate of gastric emptying in just one week; the results were sustained for more than a year.
Heartburn/GERD
Now
and then, almost everyone experiences heartburn, a burning sensation
that can radiate from the abdomen up into the chest toward the neck.
For the 20 percent of folks who experience it on an ongoing basis, it’s
probably a sign of gastroesophageal reflux disease (GERD). With GERD, a
valve between the esophagus and the stomach, called the lower
esophageal sphincter, doesn’t open and close properly, allowing acid
and contents from the stomach to flow into the esophagus. GERD also
“can cause unusual symptoms such as chronic hoarseness or sore throat,
asthma and dental problems,” says James W. Smith, M.D., director of the
Fellowship in Gastroenterology at the Ochsner Clinic Foundation in New
Orleans. Treatment often involves losing excess weight, quitting
smoking, avoiding problematic foods, not lying down after eating, and
elevating the head of your bed four to six inches. In addition,
acid-suppressing drugs may be recommended. If those don’t provide
sufficient relief, prescription-strength proton pump inhibitors may be
warranted.
Constipation
The healthy frequency of bowel movements varies tremendously, from
three per day to three per week. But if you do struggle with bowel
movements, increase your fiber and water intake and get more aerobic
exercise. A bulk fiber laxative or glycerin suppositories may also
help; don’t rely on a hard-core stimulant laxative: “Using stimulant
laxatives can weaken the colon over time,” Dr. Smith says. If you
consistently struggle with bowel movements, see your doctor.
Inflammatory bowel disease (IBD)
There
are two primary forms of IBD. Ulcerative colitis—an inflammation of the
lining of the large intestine (or colon)—often appears as bloody
diarrhea. Crohn’s disease—inflammation of the lining and wall of the
large and/or small intestine—typically produces abdominal pain,
diarrhea and often weight loss. Both increase a person’s risk of
developing colon cancer and anemia. No one knows precisely what causes
IBD, though there is likely a genetic predisposition and may be an
environmental trigger, such as exposure to a toxin or pollutant.
Whatever sets off the disease, it becomes autoimmune in nature: The
lining of the bowel becomes very inflamed, as if there were an
infection, but there is none. Neither form of IBD can be cured, though
both can go through stages of remission and relapse. Medications such
as corticosteroids, 5-ASA agents, antibiotics and immunomodulators can
be used to reduce inflammation. In severe cases, surgery may be needed.
Irritable bowel syndrome (IBS)
About 20 percent of people in this country have IBS, and while it
doesn’t increase cancer risk, it can be frustrating and disabling.
Symptoms include bouts of diarrhea or constipation, or alternations of
the two, or crampy abdominal pain, gas and bloating. The disorder can
be triggered by stress and perhaps by a bacterial overgrowth in the
small intestine. If high levels of bacteria are found on a breath test,
research suggests that treatment with an antibiotic (rifaximin) that
stays in the gut may be effective over the long term. Nutritional
approaches include a diet that’s low in fat, high in fiber and full of
fluids; eating smaller meals throughout the day; and consuming yogurt
with live active cultures or probiotic dietary supplements. For more
severe cases, medications or antidepressants to ease pain may be
prescribed.
Many people in their 40s, 50s and 60s, particularly women, suffer from fecal incontinence, a problem that can range from minor leakage to major accidents, Dr. Yoshida says. Though it often goes hand in hand with urinary incontinence, fecal incontinence can also occur on its own. People at especially high risk are those who have some form of pelvic floor dysfunction, those who have had rectal surgery or injuries during childbirth, and those who have suffered nerve damage (due to diabetes or multiple sclerosis, for instance). Many people suffer silently because they’re too embarrassed to seek help.
That’s a shame, because it can be treated. In some instances, bowel retraining, in which a person tries to have a bowel movement at a certain time of day, can help. In others, performing exercises to strengthen the pelvic muscles—often with the aid of biofeedback—can make a difference. As a last resort, surgery may be an option, especially if there’s an anatomical problem such as damage to the anal sphincter sustained during childbirth.
For
years, dietary fiber was believed to be a powerful protector against
colorectal cancer. While recent studies haven’t supported that belief,
they don’t mean you should ditch the dietary fiber. More studies need
to be done, gastroenterologists say, and in the meantime, consuming a
fiber-rich diet can promote healthy digestion in many other ways.
Soluble fiber, which is found in fruits, legumes and oat bran, acts
like a sponge, absorbing lots of water as it moves through the GI
tract, resulting in softer, larger stools. On the other hand, insoluble
fiber, which is found in vegetables and whole grains, adds bulk to
stools, making it easier for your intestines to move waste out of your
digestive system more rapidly. For optimal benefits, aim to get 20 to
30 grams of fiber a day from your diet; while increasing your intake,
be sure to drink lots of water—at least 64 ounces per day—to keep
things moving smoothly. If your diabetes has progressed to the stage
where you’re suffering from gastroparesis, a high fiber diet may be
more difficult to move through your already slowed GI tract. Creating
the best nutritional balance for your condition should be done in
consultation with your health care providers. “Discuss it with your
doctor,” advises Dr. Yoshida.
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