Why is it that everyone I know seems to be complaining about their digestion?
A friend made that observation recently and wondered why? Does digestive function just go downhill with age? What’s going on?
I, of course, have thoughts about what might be causing this. In fact there are several possible culprits; some dietary, some not. One complication of trying to identify the one cause of your discomfort is the likelihood that you’ve got more than one cause. One issue contributes to another and another. Now you’ve got 3 or 4 contributing factors. Changing one thing might not help much. You never really feel better.
So keep that in mind as you read through my indigestion list. Also keep in mind this list is by no means complete. Persistent and/or increasing pain and discomfort should be evaluated by a doctor.
- Lactose Intolerance: you may have lived decades enjoying dairy foods like milk, ice cream and yogurt with no problem. Your intestinal cells made enough of the enzyme lactase to digest the lactose in those foods. But with age, lactase production can drop. Another cause: your intestine lining can be temporarily disrupted by severe infections, medications or cancer treatments, and cells don’t make lactase. You can’t digest lactose, so gut microbes get hold of it and have a party, leaving you with gas, bloating and abdominal upset. One way to figure this out: avoid milk, ice cream and (yes sadly) yogurt for a week or more (cheese should be OK). If symptoms go away, you may have lactose intolerance. If the disruption was temporary, your intestinal cells might start making lactase again after recovery.
- Food Intolerance: This one is much harder to figure out. Is it wheat or dairy or soy or broccoli? If just one specific food causes you problems, it’s easy to connect the dots: you eat broccoli; you have stomach upset. But it’s harder to pin down foods you might eat all day every day. Another thing to keep in mind: have you switched to some supposedly “healthy” food that’s in fashion, like oat milk or gluten-free bread? Maybe you don’t tolerate those products.
- FODMAPS: What? The term Fermentable Oligo-, Di-, Mono-saccharides And Polyols refers to certain types of carbohydrates in some foods that may not be properly digested by some people. These undigested carbs are then metabolized by bacteria, leading to gas, bloating and other symptoms linked to irritable bowel syndrome. The list of foods that might contain one of these carbs is long, and a FODMAPS diet can be complicated and restrictive. Not everyone is helped. And even if you don’t tolerate one of the carb types, you might be fine with the others. Figuring out whether this helps you or not involves first going on a diet that restricts all possible FODMAP foods and then, if your symptoms have resolved, adding back one class of foods at a time to see if symptoms reoccur.
- Artificial sweeteners: Our food supply is loaded with artificial sweeteners, from beverages to desserts to bakery items, candy, cereals, syrups, yogurt and even salad dressings. They come in many different chemical forms, and some can cause digestive problems for some people. If your diet is heavy on artificial sweeteners, you might consider cutting back to see if that helps.
- Fiber added to foods: Fiber? Wait, fiber is supposed to be healthy! Yes it is, in a general sense, but now food manufacturers are adding ingredients that technically fit the definition of “fiber” (non-digestible) that gut microbes might eat up, figuratively speaking. Result: gas, bloating, other unpleasant symptoms. Inulin, cellulose, bran and wheat starch are some examples. And too much of a good thing isn’t always good. Your digestive system might rebel if overloaded with too much high fiber food like bran cereal, apples or prunes, especially if you don’t drink enough water to hydrate that fiber. Oatmeal has a major health halo, but some people just don’t tolerate it.
- Speaking of which, dehydration can also disrupt digestion. This can be especially true if you eat a lot of foods with low moisture content: snack bars, energy bars, chips, cookies, bagels, etc. Low fiber/low moisture foods like that can sit in your intestines like a lump of lead.
- Low Fiber Diet: if you eat few vegetables, fruit and whole grains, the lack of fiber can definitely cause digestive upset.
- Medications: Some medications come with warnings about adverse effects on digestive function. Antibiotics, antacids and pain meds are some examples. If you’re on multiple medications, they could also interact with each other to play havoc in unexpected ways. One clue: you notice problems soon after starting a medication. In the case of short term use, such as with antibiotics, you should recover normal function after you’ve finished your treatment.
- Probiotics: yes, probiotic supplements could potentially give some people problems. Just because something is labeled “probiotic” doesn’t mean it’s healthful. With very few exceptions, they are not regulated by the FDA. The cultures in a product might not agree with your digestive system. It’s usually best to get probiotics in food, not in pills.
- Too Much Fat: high fat meals, especially large meals, can slow digestion, leaving you feeling bloated and uncomfortable. Especially if your production of digestive enzymes has fallen off. And it’s not just saturated fat. All fat sources can contribute to the problem: fried foods, sauces, salad dressings, mayonnaise, meats, cheese and desserts.
- Too Much of Something: it might be a food or ingredient you previously enjoyed with no problem, but with age your tolerance might be reduced. Caffeine, alcohol, sugar, certain additives, chocolate, certain fruits or vegetables, cured/processed meats and hot sauces. Here’s another possible culprit: seeds and nuts, which are not digested well (because they’re not chewed well), and can irritate the intestinal lining in susceptible people. Especially now that seeds and chopped nuts are being added to all kinds of foods to boost the health image: breads, bagels, crackers, cereals, energy bars. Even produce with little seeds, like strawberries, cucumbers, blackberries and tomatoes could be suspect.
- Food that’s “off”: Culprits include food that’s been kept too long and is spoiling, packaged food that was not stored properly or produce that has started to deteriorate. Organic produce — from the farmer’s market or your own back yard — could harbor unpleasant microbes, so always wash these foods before eating. Another potential problem: rancid oils in your kitchen. Rancidity causes a harsh “off” odor, but you might not notice if you don’t sniff the bottle. And if your sense of smell has deteriorated with age, you might not be able to detect rancidity. Store oils in a dark place, and if you don’t use them up quickly, store in the refrigerator. Same is true for nuts, which can also go rancid.
- SIBO: What? Small Intestinal Bacterial Overgrowth. This poorly understood syndrome is triggered when large populations of bacteria grow in the small intestine where they do not belong. When partially digested food leaves your stomach, it’s supposed to be digested further by enzymes in the upper intestine. Instead, the bacteria start metabolizing it. Discomfort, gas and bloating are common symptoms after a meal. Why are bacteria hanging around in the upper small intestine? One theory is that the muscle contractions caused by hunger pangs are supposed to sweep bacteria and residue out, but it you never get hunger pangs, this process doesn’t happen. SIBO is diagnosed with tests by a physician, typically a gastroenterologist.
- Stress: along with anxiety and depression. Debilitating depression or anxiety should be evaluated by a physician. Stress is a two-way street. Stress can cause intestinal upset, but intestinal dysfunction can also drive stress.
- Cleanliness (or lack thereof): When was the last time you changed out your kitchen dish sponge? Cleaned the filters on the water dispenser? Cleaned out the dishwasher screens? Washed the produce drawers in the frig? Thoroughly washed your juicer or blender? Just sayin’.
- Disruption of intestinal lining/Inflammation: You may have heard the term “leaky gut”. This refers to the idea that when the intestinal lining has been disrupted, it doesn’t function properly. Digestion and absorption are affected for the worse. Plus gut microbes are also disrupted and the undesirable ones can produce toxins that can add to the inflammation. What can cause this? Prolonged intestinal infections, certain nutrient deficiencies, medical conditions, medications, stress and toxic or irritating environmental exposures are possible causes. Let’s say you had an infection and took antibiotics. The original infection might be eliminated, but you’re left with digestive disruption that can continue to cause symptoms until your intestines are healed. Certainly good diet is key to the healing process, but it can take time. If the infection caused a prolonged period of malabsorption, you might need to boost intake of some nutrients for awhile. And that’s a topic for another blog post.
Finally, with all the hype about probiotics, it’s easy to conclude that probiotic foods like yogurt, or some glitzy probiotic supplement will magically fix your digestive problems. Unlikely. Not that probiotic foods aren’t part of the solution. But they aren’t the only solution. Probiotics alone can’t fix a damaged gut lining. They definitely won’t cancel out the adverse effects of high fat meals or over-consumption of artificial sweeteners or a low fiber diet or medications. A healthy digestive system depends on multiple factors. Probiotics are just one piece of the puzzle.