A Public Service Site from Esteem & Associates, Inc.

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"Digestive Do's And Don'ts"

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The digestive system performs the amazing task of changing food into the fuel your body needs to carry on. Most of the time this system stays remarkably free of trouble. With age, however, your body may begin to work less efficiently in some ways and your lifestyle may change. Afterward, digestion may be a problem every now and then.

During the chemical process of digestion, food is broken down into pieces tiny enough to be taken into the blood. The blood, in turn, carries these food elements to cells in all parts of the body where they are changed into energy or used to form new structures such as body tissue.

Many body organs are involved in the process of digestion: the esophagus, stomach, pancreas, gallbladder, liver, small intestine, and colon. Many people have few, if any, digestive problems related to aging. Sometimes there are changes affecting the length of time food travels through the system. For example, digestive muscles might move slower or produce less acid.

Lifestyle changes--such as increased use of medicines, reduced exercise, and changes in eating habits--can hamper the digestive system.

The Digestive System

Digestion begins in the mouth. As you chew, tiny glands give off a fluid (saliva) that moistens food so it can be swallowed easily. Saliva also contains an enzyme that begins to change carbohydrates--like vegetables and breads--into a form the body can absorb. Once the food is swallowed, wave-like (peristaltic) motions push it through the esophagus and into the stomach. Stomach muscles crush and mix the food with enzymes and acids, creating a mixture called chyme. The stomach allows small amounts of the chyme to enter the duodenum, the first part of the small intestine. It is in the duodenum that most digestion takes place. There, juices from the liver and pancreas break down fats, protein, and carbohydrates. As the digested food passes into the last two-thirds of the small intestine, nutrients are absorbed into the blood. The remaining material is pushed into the colon, which is part of the large intestine. This material includes water and waste--the part of food that is not digested, such as fiber from fruit, vegetables, and grains. The lining of the colon absorbs water from the material and, when the waste is solid enough, nerves in the wall of the large intestine signal the urge for a bowel movement.

Taking Care of the System

To keep your digestive system working at its best:

• Eat a well-balanced diet that includes a variety of fresh fruits, vegetables, and whole grain breads, cereals, and other grain products
• Eat slowly and try to relax for 30 minutes after each meal
• Exercise regularly
• Drink alcohol in moderation, if at all
• Avoid large amounts of caffeine
• Use caution when taking over-the-counter drugs and always follow your doctor's directions exactly when taking prescribed medications.

When to See a Doctor

No matter how well your digestive system is treated, there are times when things go wrong. Often the problem will take care of itself. Sometimes, symptoms can be a signal that something more serious is wrong. Some important warning signs are:

• Stomach pains that are severe, last a long time, are recurring, or come with shaking, chills, and cold, clammy skin
• Blood in vomit or recurrent vomiting
• A sudden change in bowel habits or consistency of stools lasting more than a few days (for example, diarrhea for more than 3 days or the sudden onset of constipation)
• Blood in stools or coal-black stools
• Jaundice (a yellowing of the skin and the whites of the eyes) or dark, tea-colored urine
• Pain or difficulty in swallowing food
• Loss of appetite or unexpected weight loss
• Diarrhea that wakes you up at night.

If you have any of these symptoms, see a doctor at once.

Digestive Diseases

Disorders of the digestive tract cause more hospital admissions than any other group of diseases. They occur most often in people who are middle-age or older.

Stress, infection, diseases, poisons, and defects present at birth can cause digestion problems. But the causes of many digestive diseases are unknown. There is evidence that diet may be involved in a few of them. For example, eating less fiber (the part of the plant that is not digested) may play a role in constipation, cancer of the colon, and diverticulosis, a condition in which small sacs form in the intestinal wall. Alcoholism has been linked to inflammation of the pancreas (pancreatitis).

Progress is being made in diagnosing many digestive diseases. In addition to the upper and lower gastrointestinal series, which uses x-rays and barium to find trouble spots, doctors can use a flexible instrument called the endoscope to see inside the esophagus, stomach, duodenum, and colon. The endoscope is also used to perform biopsies and some forms of surgery. There are also techniques for getting better images of body organs, such as ultrasound and the CT scan (computer tomographic scan), which takes detailed, three-dimensional x-rays.

Treatment advances include new drugs for peptic ulcers, a vaccine to prevent hepatitis B, and microsurgery to remove gallstones.

Some common digestive disorders are listed below.

Constipation. This is a decrease in the number of bowel movements, along with long or hard passing of stools. Older people report this problem much more often than do younger ones. Most cases of constipation can be easily treated. "Regularity" does not necessarily mean one bowel movement every day. Normal bowel habits can range from three movements each day to three each week. Eating a poor diet, drinking too few liquids, changing activities, taking certain prescription medications, or misusing laxatives can lead to constipation. Regularity is usually improved by eating foods high in fiber and staying physically active.

Diarrhea. When body wastes are discharged from the bowel more often than usual in a more or less liquid state, the condition is called diarrhea. There are many possible causes, but many cases are related to infection or improper handling of food. Treatment of the underlying disorder is needed but, most important, replacing lost fluids, even when there is no feeling of thirst, is essential.

Diverticulosis and diverticulitis. In diverticulosis, which is common in older people, small sacs form on the wall of the large intestine. Although they usually cause no symptoms, occasionally there is pain in the lower side of the abdomen. Treatment includes a diet high in fiber and liquids. Diverticulitis develops after the sacs become inflamed and causes a fever. Treatment consists of bed rest and antibiotics.

Functional disorders. Sometimes symptoms such as pain, diarrhea, constipation, bloating, and gas are caused by a functional disorder such as irritable bowel syndrome. In these disorders there are no signs of disease and yet the intestinal tract still fails to work properly. A functional disorder may cause discomfort, but it is unlikely to lead to a serious disease. A doctor may prescribe medication to relieve symptoms. Because diet and stress are thought to trigger functional disorders, the same guidelines that help to keep your system running smoothly should help control the symptoms.

Gallbladder disease. In this disease, stones (usually composed of cholesterol) form in the gallbladder. These stones are often silent--that is, they cause no symptoms or discomfort, but they sometimes result in problems requiring drug treatment or surgery. Severe pain in the upper abdomen may mean that a gallstone has lodged in one of the tubes leading from the gallbladder.

Gas. Some gas is normally present in the digestive tract. It is usually caused by swallowing air, stress, or eating foods such as cauliflower, brussel sprouts, brown beans, broccoli, bran, and cabbage. (Since these foods are good sources of fiber and vitamins, eat smaller amounts rather than removing them from the diet.) The body rids itself of gas by belching or passing gas. However, if gas collects in the digestive tract, it can lead to pain and bloating.

Heartburn. A burning pain felt behind the breastbone that occurs after meals and lasts for anywhere from a few minutes to several hours is called heartburn. It is caused by stomach acid washing backward up into the tube connecting the mouth and stomach (esophagus). Heartburn can be brought on by eating spicy or rich foods such as tomato products, chocolate, fried foods, or peppermint, or by smoking cigarettes. It is relieved by changing your diet, taking an antacid, sleeping with the head of the bed raised 6 inches, or stopping cigarette smoking. If pain persists, see a doctor.

Peptic ulcer. This is a sore on the lining of the stomach or the small intestine just below the stomach (duodenum). An ulcer occurs when the lining is unable to resist the damaging effects of acid and pepsin that are produced by the stomach to digest foods. Antacids, which neutralize acid in the stomach, and drugs that decrease the production of acid or coat the ulcer are very useful in treating peptic ulcer. Continued pain should be checked by a doctor.

Indigestion. Known as dyspepsia, this common condition involves painful, difficult, or disturbed digestion. The symptoms include nausea, regurgitation, vomiting, heartburn, abdominal fullness or bloating after a meal, and stomach discomfort or pain. Overeating or eating certain foods can also cause symptoms, but they may also be related to other digestive problems such as peptic ulcer, gallbladder disease, or gastritis. Indigestion usually can be controlled through diet or by treating the specific disorder.

Hemorrhoids. When veins in and around the rectum and anus become weakened and enlarged, they are called hemorrhoids. This condition may be caused by pressure in the rectal veins due to constipation, pregnancy, obesity, or other conditions. The veins may become inflamed, develop blood clots, and bleed. Hemorrhoids are treated with frequent warm baths, creams, or suppositories, and if necessary, by injections or surgery. Eating high-fiber foods and drinking fluids may also help.

Hiatal hernia. In this condition the esophagus breaks through the opening in a thin muscle separating the abdominal cavity from the chest cavity. Hiatal hernias are common after middle-age and usually have no symptoms. But if the lower end of the esophagus becomes weak, stomach acids may flow back to the esophagus and result in a sense of burning. Most problems can be treated without medicines or surgery. For example, a change in eating habits or losing weight may be all that's needed to remove discomfort.

Milk intolerance. Also called lactose intolerance, this is the inability to digest milk and milk products properly due to a lack of lactase, the intestinal enzyme that digests the sugar found in milk. Some people develop this problem as they grow older. The symptoms--which include cramps, gas, bloating, and diarrhea--appear 15 minutes to several hours after consuming milk or a milk product. Most people manage the problem by mixing milk with food or beverages, eating processed cheeses and yogurt, taking smaller servings more frequently, or adding a special nonprescription preparation such as acidophilus to milk that makes it easy to digest. When eating fewer dairy products, help keep bones strong by consuming calcium rich foods such as dark green leafy vegetables, salmon, and bean curd. Since these foods will not provide as much calcium as dairy products, a doctor may suggest supplements.

Ulcerative colitis. This chronic disorder usually develops in young adults, but it also appears in older people. In ulcerative colitis, parts of the large intestine become inflamed causing abdominal cramps and often rectal bleeding. Joint pain and skin rashes may also develop. The symptoms are usually controlled with drugs, but some patients eventually need surgery. Sometimes irritable bowel syndrome (IBS) is incorrectly called "spastic colitis." However, IBS does not cause inflammation and it is not related to ulcerative colitis.

For further information about these and other digestive problems, consult your doctor. You can also write to the National Digestive Diseases Information Clearinghouse, P.O. Box NDDIC, 9000 Rockville Pike, Bethesda, MD 20892.