Sunday 16 December 2018

14 ways to manage indigestion

Looking after your gut health is vital during the festive season when we often overindulge - and it can even improve your mood

There are steps you can take to manage indigestion over Christmas
There are steps you can take to manage indigestion over Christmas
Time to give up the fizz, ladies
Avoid piling your party plate too high over Christmas

Julia Molony

Overdoing it on mulled wine and minced pies can lead to major stomach gripes at this time of year as the unholy trinity of bloating, acid reflux and abdominal discomfort make their presence known. Before reaching for the Rennies again, consider the following simple tips on how to manage indigestion and keep your gut merry this Christmas.

1 Consistency is key

It's the change of diet over Christmas in terms of the "frequency, amount and quality" of food that causes problems, says consultant gastroenterologist Professor Nap Keeling, who runs a clinic at St James's Private Hospital in Dublin. "Stick to the same amount and quality as you'd usually eat throughout the rest of the year," he advises, and you'll avoid aggravating digestive complaints. The same applies for alcohol: "Stick to amounts you'd usually drink," he says, and resist the urge to binge. He also suggests that people with a history of dyspepsia take a proton pump inhibitor every night for two weeks over the Christmas period.

2 Become pH savvy

Time to give up the fizz, ladies
Time to give up the fizz, ladies

Dr Jonathan Aviv is a clinical professor of otolaryngology and a world authority on acid reflux. In his book, The Acid Watcher Diet, he prescribes a low-acid dietary regime for 28 days which he says will heal inflammation in your gut and reduce the release of pepsin - a naturally occurring digestive enzyme which, he says, contributes to irritation and the erosion of tissue in the throat. He counsels the Power of 5 Rule - only eating food that has a pH of 5 and above. Permitted foods include fish such as salmon and sea bass, vegetables, hard cheeses, chicken breasts, eggs, fresh fruit and vegetables. High-acid food such as tomatoes and citrus fruits are to be avoided.

3 Take a probiotic

"Over the Christmas holidays a lot of people get a thing called gut dysbiosis, a very strong form of indigestion," says Avril Ivory, who is a health psychologist, acupuncturist and naturopath at Vico Health. "We tend to have an increased level of saturated fat over the Christmas, as well as more toxins, particularly alcohol. When you start putting all of that into the gut, the gut just gets overloaded," she says. She recommends planning in advance. "Buy a really good probiotic and take it coming up to Christmas, before you put in all of this food and drink. The bacteria in the gut will then be able to break down what you are putting in, and it will help to extract the energy and vitamins and minerals in the food, and regulate blood sugars," she says. "For the probiotic to work properly we also need to have prebiotics in the diet - leeks, garlic, onions, artichokes," she adds.

4 Check your breath

Melissa Dooley, gastrointestinal physiologist and founder of the Gastrolife clinics, advises patients to get to the root of their symptoms by undergoing simple breath tests to check for two common gut disorders: small intestinal bacterial overgrowth, and Helicobacter pylori infection. The former, caused by too much bacteria in your small intestine is problematic because "instead of your food getting broken down in the normal fashion, the bacteria starts to break it up for you, which produces hydrogen, methane, and carbon dioxide". Of these, it's the carbon dioxide which causes the most trouble. "It either travels up, causing bloating and increasing abdominal pressure, or it can travel distally towards your colon and cause a lot of flatulence and wind. It's very prevalent in people with IBS," she adds. Diagnosis requires "a specialist test, as it can be missed during routine examinations and endoscopy."

Helicobacter pylori, she explains, is a common microbe that lives in many people's guts. It can cause gastritis - "inflammation in your tummy, epigastric pain and abdominal discomfort. And it can also lead to peptic ulcers. People could get the burning, acid-type feeling around the epigastric region in their stomach. A lot of people describe it as a taste coming up into the back of their mouth, or a sour taste in their mouth, or complain of foul-smelling breath - similar symptoms to someone suffering from gastric reflux," she says. If diagnosed, the first thing is to see your GP. "If the test comes back positive, the standard treatment for Helicobacter pylori is "triple therapy - taking two antibiotics along with a proton pump inhibitor. If the test for SMBO is positive, the treatment differs, she says "depending on whether the bacteria are producing hydrogen gas or methane gas. In both cases the aim is to reduce the bacteria in your small intestine, so that your food can be broken down in a normal fashion.

Avoid piling your party plate too high over Christmas
Avoid piling your party plate too high over Christmas

"If you are experiencing these symptoms," she adds, "it is important to see a medical professional because there can be important implications of gastric reflux and they can potentially lead to more serious conditions."

5 Quit the fizz

Carbonation reduces the pH of any beverage, warns Dr Aviv. "The gas bubbles in carbonated beverages distend the stomach almost two to one over non-carbonated beverages," he warns. "Think about stomach distension as a balloon being blown up, its contents shooting up into the adjacent oesophagus. Sugary and diet sodas are so corrosive to the delicate tissues of your oesophagus and beyond, including the delicate vocal cords, that I liken these substances to the battery acid in your car."

6 Give up the cigs

Several academic studies have supported an association between cigarette smoking and reflux. Nicotine is thought to be the main culprit, causing a relaxation of the muscle of the lower oesophagus, which allows acid to leak back up into the gullet.

7 Try Acupuncture

"Usually if somebody comes into the practice with gut overloading and bloating I start working on the liver meridian which will support their gut function," says Avril Ivory. "In traditional Chinese medicine we would say we all have a tendency towards imbalance in one organ system. People will know - if they are moody, if they're belching, if their stool goes a lighter, paler yellow colour, if they're waking between 2-4am in the morning, if they are irritable," all these signs, she says, point to an overburdened liver. "The Chinese would say the liver is incredibly important in having stable mood. The rows at Christmas are not just a myth, they really happen. That's really related to people being really irritable because their liver is overburdened."

8 Get outdoors

"One of the most important things to do when we are overburdening our system is to get out there twice a day if possible and walk briskly in fresh air," Ivory adds. "From a Chinese perspective that moves stagnant liver Chi. It calms it down, it makes our emotions more balanced. And when we are in a liverish state we are more reactive so if a relative is driving us mad, we are much more likely to react to that person. Whereas if we've been out for a 20-minute walk and done some deep breathing, breathing is really powerful for liver health, we're far less likely to be reactive."

9 Get enough rest

According to Norman Robillard, microbiologist and author of Fast Tract Digestion: Heartburn, adequate rest is vital to digestive health. "Rest helps your body have more energy for the hard work of digestion that requires strenuous, sustained and coordinated muscle contractions. Rest also reduces your stress level, the amount of acid your stomach produces between meals, and influences, if only indirectly, almost every aspect of your digestive process," he writes.

10 Eat slow, chew long

"How you eat is just as important as what you eat," counsels Robillard in his book. "Many of us race through our meals in an effort to save time for more pressing activities. But fast and furious eating is a severe disadvantage for your body's ability to digest food. Take smaller bites, eat slowly and chew well. Consider counting to 20 on every mouthful," he says. "The amylase enzyme in your saliva can only act on small particles of food and only works until the starch reaches your stomach - at which point the amylase is destroyed. If your salivary amylase doesn't have the time to do its job, you'll have to rely on the pancreatic amylase in your small intestine, which is capable of finishing off the digestive process, but not the entire job of breaking down starches. I would never eat bread, rice, potatoes, corn other wheat or grain products or pasta without chewing each bit to completion. If I didn't, these foods would absolutely give me severe heartburn."

11 Eat more fibre

Dr Aviv is an advocate of upping your daily fibre intake to tackle the burn. "Dietary fibre has been shown to increase bowel movement size and accelerate transit time," he argues. "When your digestive system isn't functioning properly, the pressure created by constipation, gas or excess bloating can extend up to the lower oesophageal sphincter and weaken the important closure that shuts gastric acid out from the tissues above. As fibre works to improve the efficiency of your digestive system, it will also help decrease the type of upward pressure that can open the door to acid damage. He suggests a minimum of 1lb of vegetables and ½lb of raw, high pH fruit daily.

12 Cut out wine

Alcohol is a well-known culprit for all manner of digestive complaints, but none more so than gastric reflux. Wine, particularly, according to Dr Aviv, highly acidic white wine, is the worst offender. Happily total, long-term abstinence isn't necessary. After a 28-day break from all alcohol and low pH foods, Aviv's regime permits a moderate amount of potato or corn-based vodka, which has pH of 5 or higher, and surprisingly tequila.

13 Don't lie down after a meal

That midnight snack of leftover smoked salmon on soda bread might seem like just the thing after a long evening of telly-binging between Christmas and New Year. But going to bed on a full stomach is a recipe for uncomfortable regurgitation. Gravity is your friend when you wish to avoid backflow of stomach acids into the gullet. It's best to remain upright, either sitting or standing for at least a couple of hours after a meal. Or better still, go for a walk.

14 Try ginger tea

A study published in the European Journal of Gastroenterology and Hepatology found that ginger appears to have a positive affect on the gastrointestinal tract, speeding up the transit of food from the stomach into the lower intestine. The researchers concluded that the mechanism was likely due to the phenolic compounds found in the ginger root which stimulate digestive enzymes.

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