Listen to Your Gut!

Hallie Hudson - in Circle.jpg

By Hallie Hudson, PharmD, TTS

So, this month we are going to talk a little bit about your digestive system and how to incorporate healthy lifestyle changes to improve your digestive health.

Your digestive system breaks down food and liquid into small parts that can be absorbed by your body. These small parts (or nutrients) are used by your body’s cells for energy. Your digestive tract, also called your gastrointestinal (GI) tract, is made up of the esophagus (food tube), stomach, large and small intestines, liver, pancreas and gall bladder.

Here is a list of some common digestive system conditions:
·         Heartburn
·         Constipation
·         Celiac disease
·         Diarrhea
·         Diverticulitis
·         Gallstones
·         Irritable bowel syndrome (IBS)
·         Peptic ulcer disease

For many people, these conditions can significantly affect their daily lives. People with digestive health illnesses may experience daily discomfort, which can negatively impact their quality of life.

There are a couple of digestive health conditions that I would like to talk about in more detail: heartburn and constipation. These two conditions are often asked about at the pharmacy and, often times, can be treated by making lifestyle changes or taking over-the-counter medications.

 Heartburn

So, let’s talk a little more about heartburn. Heartburn is also known as acid reflux or gastroesophageal reflux disease (GERD). Heartburn is characterized by a feeling of burning in your chest or throat and it has nothing to do with your heart.

What causes heartburn?

Heartburn is caused by the sphincter at the bottom of the esophagus (the lower esophageal sphincter) failing to close properly or opening at the wrong time. Heartburn can also be caused by a hiatal hernia, which is when part of the stomach moves above the diaphragm.  Heartburn happens when stomach acid becomes backed up in the esophagus, which moves food from your mouth to your stomach. 

What triggers heartburn?

Well, heartburn can be triggered by many things. The most common cause of heartburn is food that is acidic or high in fat (like tomatoes, onions, chocolate, coffee, citrus fruits, cheese and peppermint). Large meals or spicy foods can also trigger heartburn. Certain medications, such as aspirin and ibuprofen, can also trigger heartburn symptoms.

In addition to foods and medications, obesity and pregnancy can also trigger heartburn due to added pressure on the abdomen and stomach.

Symptoms of heartburn usually begin shortly after eating and may persist for hours or go away within minutes. Other symptoms include coughing, hoarseness, a sour taste in your mouth, and the feeling that food is caught in your throat. Symptoms are often worsened after large meals, leaning forward, or lying down flat. Those affected may often awaken from sleep with heartburn.

What should you do to prevent or treat heartburn?

One of the best ways to prevent heartburn is to avoid trigger foods. In addition, try eating smaller, more frequent meals and wait about 4 hours after eating before lying down. It’s also important to avoid alcohol, aspirin, ibuprofen, and caffeine, which can also trigger or worsen heartburn symptoms.

There are also some over-the-counter medications that can help relieve or prevent heartburn symptoms.

What medications are available to prevent or treat heartburn?

First, let’s talk about antacids. Antacids can be taken after meals, at bedtime, or when needed to alleviate heartburn symptoms. Antacids help relive heartburn symptoms by binding to excess acid in the stomach and by coating the esophagus. Antacids work quickly to ease symptoms, but they may not be the best choice to prevent heartburn symptoms.

o   Examples of Antacids:
-  Tums®
-  Pepto-Bismol®
-  Rolaids®
-  Alka-Seltzer®

Next, we’ll talk about histamine-2 receptor antagonists (H2Ras). H2Ras reduce stomach acid, but not as quickly as antacids, like Tums®. However, H2RAs typically provide longer relief and can be taken prior to meals to help prevent heartburn.

o   Examples of H2RAs:
-  Pepcid® (Famotidine)
-  Zantac® (Ranitidine)
-  Tagamet® (Cimetidine)

Last, we’ll talk about proton pump inhibitors (PPIs). PPIs also work to reduce stomach acid, but once again, they do not work as quickly as antacids. Like H2Ras, PPIS typically provide longer relief. PPIs should be taken 60 minutes prior to your first meal of the day to help prevent the release of stomach acid.

o   Examples of PPIs:
-  Prilosec® (Omeprazole)
-  Nexium® (Esomeprazole)
-  Prevacid® (Lansoprazole)

Remember, it’s important to talk to your doctor or pharmacist prior to starting any new over-the-counter medication to make sure it does not interact with any of your other medications.

Are there any complications of heartburn?

Heartburn or acid reflux over prolonged periods of time can be severe enough that acid wears away the enamel on the teeth and causes decay.

If heartburn is ignored or left untreated, recurrent irritation and inflammation of the esophagus can lead to ulcers. Ulcers are small areas of tissue breakdown, which can cause serious bleeding. Other complications include scarring and changes in the cells that line the esophagus. This can cause a condition known as Barrett’s esophagus, which is associated with an increased risk of esophageal cancer.

When should I see the doctor?

If you are experiencing symptoms of what you may think could be heartburn, it is important that you see your doctor so he or she can rule out any other conditions that could present similarly to heartburn.

 Constipation

I know constipation isn’t something we typically like to talk about, but did you know that approximately 4 million Americans experience frequent constipation? In fact, constipation accounts for about 6 million visits to health care providers in the United States every single year.

What are the most common causes of constipation?
·         Low fluid and/or dietary fiber intake
·         Side effect due to certain medications including, but not limited to:
o   Iron or calcium supplements
o   Antacids with aluminum or calcium
o   Certain types of heart or blood pressure medications (i.e., calcium channel blockers, beta-blockers)
o   Antidiarrheals (i.e., Imodium®)
o   Opioids (prescription pain medications)
·         Narrowing or blockage of the large intestine due to scarring or colon cancer
·         Ineffective contraction of the colon muscles due to irritable bowel syndrome or other disease
·         Hormonal disturbances due to thyroid disorders or diabetes
·         Neurologic conditions such as Parkinson’s disease or multiple sclerosis
·         Certain conditions including anxiety, depression, pelvic floor dysfunction, dementia, and others

What are some ways to relieve constipation?

First, let’s talk about making some important lifestyle changes. It’s important to start making lifestyle changes that can help regulate your digestive health and promote healthy, regular bowel movements. By increasing daily physical activity, fluid intake, and fiber intake, you can help promote a healthy digestive system and regular bowel movements.

So, what is fiber? Fiber is a carbohydrate from plants that can’t be broken down by enzymes in our digestive tract. There are two important types of fiber: water-soluble and water-insoluble fiber.

  • Soluble fiber: Water-soluble fibers absorb water during digestion, and they increase stool bulk. Soluble fiber can be found in vegetables, legumes (like dry beans, lentils, and peas), fruits (like apples, oranges, and grapefruits), barley, oats, and oat bran.

  • Insoluble fiber: Water-insoluble fibers remain unchanged during digestion. These fibers help to promote normal movement of intestinal contents. Insoluble fibers can be found in fruits with edible peel or seeds, vegetables, cereals, bran, rolled oats, whole grain products (like wheat bread, pasta, crackers), buckwheat, and brown rice.

How much fiber do I need in my diet?

The daily recommended intake of fiber is 25 grams for women ages 14 to 50 and 38 grams for men ages 14 to 50. For women over the age of 50, the daily recommended intake is 21 grams, and for men over the age of 50, the daily recommended intake is 30 grams. About one-fourth of your daily dietary fiber intake should be from soluble fiber (so about 6 to 8 grams per day).

You should increase your fiber intake slowly over 7 to 14 days to prevent bloating, cramping, and discomfort. Be sure to drink plenty of water (about 8 to 10 cups per day) as well.  

What should I do if I consume enough fiber, but still experience occasional constipation?

As you may know, there are many over-the-counter products that can be used to help relieve constipation. In fact, when you are walking down the digestive health aisle, you may even feel overwhelmed by all the different products that are available.

It’s important that you try an over-the-counter medication that is going to best help you. Some of the products work very quickly, like rectal suppositories, and others may take several hours or even a couple of days to start working.

Let’s take a look at some of the over-the-counter products that are available at the pharmacy.

Product Type

How does it work?

When will it start working?

Potential Side Effects

 

Oral Osmotics

Magnesium Hydroxide – Phillip’s Milk of Magnesia® Polyethylene Glycol (PEG) 3350 – MiraLax®

Increases the flow of water in the intestines to allow easier passage of stool

MiraLAX: 12 to 96 hours

Milk of Magnesia: 30 minutes to 6 hours

Cramping, bloating, gas, nausea, diarrhea, increased thirst


Oral Bulk Formers

Psyllium – Metamucil®, Methylcellulose – Citrucel®

Absorbs water to form soft, bulky stool, which
allows for
normal
contraction
of intestinal
muscles

Cramping, bloating, gas, or increased constipation if not taken with enough water

12 to 72 hours


Oral stool softeners

Docusate – Colace®, Surfak®

Helps liquids mix into the stool and prevent dry, hard stool masses

24 to 72 hours

Cramping, nausea


Oral stimulants

Bisacodyl – Dulcolax®,
Senna – Senokot®

Trigger the muscle in your intestine to contract, which moves the stool through the intestines

6 to 12 hours, but could be up to 24 hours

Cramping, nausea, diarrhea, urine discoloration with senna and cascara derivatives


Rectal suppositories

Dulcolax® suppositories – Stimulant

For the Dulcolax® suppository, it would work similarly to the oral stimulant version

15 to 60 minutes

Rectal irritation, diarrhea, cramping


It’s important to note that stool softeners do not get the bowels moving if you are already constipated. Instead, stool softeners help do exactly what they say: they help to soften the stool. Stimulant laxatives help get the bowels contracting and moving to promote a bowel movement. MiraLAX® is another common laxative that is generally well tolerated. It works by drawing in water to soften the stool and naturally stimulate the contraction of the colon.

Some products are combination products that combine different types of laxatives such as a stool softener and a stimulant. Talk to your doctor or pharmacist to see if a single-ingredient or combination product is right for you. Generally, you should take laxatives at bedtime. In addition, you should take them two hours before or after any medications.

What should I do if I am pregnant?

For constipation relief in women who are pregnant, increasing both fluid and fiber intake is recommended.

Bulk-forming agents (i.e., Metamucil®) and MiraLAX® are often considered as “first-line” treatment during pregnancy. With bulk-forming agents, be sure to increase intake slowly and drink with plenty of water. During pregnancy, MiraLAX® is only recommended for short-term or intermittent use. Docusate, a stool softener, can also be used during pregnancy. However, you should always talk to your doctor about which product would be best for you.

When should I see the doctor?

You should talk to your doctor or healthcare provider if constipation doesn’t improve after one week despite the use of laxatives. In addition, you should call if you are experiencing bad stomach pain, nausea, or vomiting.

If you experience any of the following symptoms, you should contact your doctor for further evaluation:

·         Changes in bowel habits after 50 years of age
·       Blood in stool
·         Anemia
·         Severe abdominal pain or cramping
·         Weight loss of 10 pounds or more in the past six months
 

As you can see, your digestive health can be directly affected by the foods you eat and the lifestyle you live. It’s very important that you take the right steps to improve your digestive health.

Let’s take a quick look at some ways you can help improve or maintain your digestive health:

1.       Eat a high-fiber diet
2.       Limit foods that are high in fat, fried, or processed
3.       Go for lean meats
4.       Drink plenty of water
5.       Exercise regularly
6.       Manage stress
7.       Refrain from smoking, excessive caffeine, and alcohol
8.       Maintain a healthy weight

By practicing an overall healthy lifestyle, you can help manage or even prevent digestive health issues. 


This information is for educational purposes only and is not intended to replace the advice of your doctor. We encourage you to discuss with your doctor any questions or concerns you may have. 


References:

1.        Take the Burn Out of Heartburn. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2016/Aug/Take-the-Burn-out-of-Heartburn-10028. Accessed May 15, 2019.

2.        Constipation 101. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2017/Dec/Constipation-101-11779. Accessed February 18, 2019.

3. Treatment of Constipation in Adults. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2015/Jun/Treatment-of-Constipation-in-Adults-8517. Accessed February 18, 2019.

4. GI Med Use in Pregnancy and Lactation. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2013/Jun/GI-Med-Use-in-Pregnancy-and-Lactation-5709. Accessed February 18, 2019.