‘B’ is for Bloating (and wind)

INDIGESTION

(Bloating and Wind)

 

Indigestion, also known as dyspepsia, is a condition of impaired gastric function. It is not a disease in itself but a group of symptoms, including pain in the upper abdomen, flatulence (wind), bloating and nausea. Heartburn is distinct from indigestion but is often included within the description of indigestion. Dyspepsia is a common complaint that can occur at any age. Symptoms may be episodic, recurrent or chronic.

 

Aetiology

Indigestion can have many possible causes including:

• Bad lifestyle habits. It can be triggered by:
• Eating too much or too quickly
• Highly processed foods, junk food, fatty or spicy foods
• Overindulgence in alcohol, caffeine or carbonated drinks
• Food sensitivities and allergies
• Irritating foods, e.g. citrus fruit, onion, garlic, and tomatoes
• Smoking
• Fatigue, stress or anxiety
• Swallowing excessive amounts of air while eating
• A variety of upper digestive tract conditions, e.g. peptic ulcers, gastro-oesophageal reflux disease (GORD) with or without oesophagitis, gastroparesis (delayed gastric emptying), gastritis, Helicobacter pylori infection, hiatus hernia, low or high output of stomach juices and cancer.
• Non-upper gastrointestinal tract (GIT) causes such as heart disease, pancreatic or hepatobiliary abnormalities, IBS, pregnancy and obesity.
• Certain drugs, e.g. NSAIDs, corticosteroids, some antibiotics, bisphosphonates, contraceptive pills and thyroid medication.

However, in the majority of cases there does not seem to be a clear pathological cause for the symptoms of indigestion. When the exact cause is unidentified it is called functional dyspepsia (FD). Gastric distension and acid sensitivity may play a role in FD symptoms. Psychosocial and psychological factors are also suspected to be involved.

 

Signs and symptoms

• Bloating
• Flatulence
• Abdominal pain
• Belching
• Early satiety (feeling full quickly)
• Uncomfortable fullness after eating
• Nausea
• Vomiting
• Rumbling noises
• Unintentional weight loss
• Anorexia
• Indigestion is often accompanied by heartburn (a separate condition)

Medic alert

Seek medical advice if there is evidence of any of the following:

• Vomiting blood
• Persistent vomiting
• Bloody or dark coloured tarry stools
• Severe dysphagia (difficulty swallowing)
• Palpable abdominal mass
• Iron deficiency anaemia

 

Naturopathic perspective

In traditional naturopathic philosophy the gut is considered the seat of all health. Any dysfunction in the digestive system can lead to major health consequences.                                                              There are several components of the digestive system that need to be considered in patients presenting with dyspepsia.

• Diet – The diet has a direct impact on the function of all of the areas below. Dietary intervention (e.g. elimination of specific foods) is extremely important in the management of indigestion.
• The intestinal barrier prevents the entry of pathogenic microorganisms into the circulation and regulates the absorption of nutrients, electrolytes and water. A defective barrier can cause oxidative stress, inflammation, leaky gut (intestinal permeability) and excessive sensitivity to normal degrees of acid exposure.
• Bacteria – A balanced intestinal flora protects the GI tract from pathogenic bacteria. In addition, it supports the health of the intestinal barrier, protects against leaky gut and promotes intestinal immunity. Dysbiosis needs to be treated with prebiotics, probiotics and antimicrobials.
• Enteric nervous system (ENS) – Dysfunction within the ENS in the gut can result in increased pain sensation to stimuli such as gastric acid and distension. Stress can have a negative influence on pain perception as well. Treatment aimed at improving neural function and managing stress levels can have a positive effect on gastrointestinal symptoms.
• Digestive secretions (hydrochloric acid, enzymes) – Although hydrochloric (HCl) acid levels may be high in some cases, dyspeptic patients often present with low levels. Restoring gastric acidity will improve protein digestion and the absorption of vitamin B12, iron and calcium.

Proper digestion also requires adequate amounts of digestive enzymes. Bloating, fullness and slow gastric emptying may be associated with digestive enzyme deficiencies.

• Immune system – Around 75% of the immune system is found in the GIT. Immune balance is influenced by gut microbiota and, in turn, microbiota is influenced by immune balance.      An excessive immune response can result in intestinal inflammation which may lead to gut barrier dysfunction.

 

 

 

 

Nutrition

The best way to prevent, treat and gain relief from indigestion is by changing and improving nutritional and lifestyle habits:

• Reduce the size of meals to avoid overeating. Breaking down daily food intake into five or six smaller meals makes lighter work for the digestive system.
• Eating slowly and chewing food thoroughly are the first steps toward good digestion.
• Include adequate, good quality protein for barrier repair and immune support.
• Avoid or minimise the consumption of the following foods and drinks as they may cause indigestion:
  • Caffeinated foods and beverages
  • Alcoholic and carbonated drinks
  • Fatty or spicy foods, processes foods and foods high in salt or refined sugar
  • Acidic foods, including tomatoes and citrus fruits
  • Cabbage, broccoli, beans, Brussels sprouts
  • Monitor individual effects of foods and adjust diet accordingly
• Certain herbs and spices promote digestion, soothe the gastrointestinal tract and reduce wind, e.g. ginger, turmeric, parsley and garlic.
• Increase intake of dietary anti-inflammatories by including pineapple (bromelain) and paw paw (papain). The digestive enzymes bromelain and papain assist with digestion.
• Garlic aids in digestion and destroys unwanted bacteria.
• Adequate fibre in the diet is important to bulk up the stool and to promote the growth of beneficial gut bacteria.
• Drink plenty of water daily to neutralise acids and to reduce bloating.

 

Beyond the diet

• If stress is a trigger for indigestion, use calming techniques such as exercise, meditation and biofeedback.
• Smokers should consider quitting, or at least not smoking right before eating, as smoking can irritate the stomach lining.
• Wear loose, unrestrictive clothing around the abdomen.
• Avoid bending or lying down right after eating.
• Wait at least 2-3 hours after the last meal of the day before going to bed.
• Raise the head of the bed 15 to 20 cm.
• Reduce weight if obesity is an issue.
• Exercise aids the digestive process.
• Drink a small glass of water 30 minutes before eating.
• Do not drink with a meal, or for at least two hours after meal.

 

Supplements

Digestive enzymes – Especially proteolytic enzymes to assist in the breakdown of protein. Probiota Pro Digestion Intensive covers all the usual suspect food groups.

Betaine HCl and pepsin are essential for breaking down, metabolizing and absorbing foods. Furthermore, HCl acid kills many parasites and other harmful microorganisms.

Vitamin A for mucosal immune system integrity. Vitamin A also provides protection against harmful pathogens.

B vitamins are essential for the metabolism of fats, proteins and carbohydrates as well as for the stimulation of gastric and bile secretions.

Glutamine to support the tight junctions between the epithelial cells and to reduce mucosal permeability.

Colostrum to boost the immune system and to reduce gut permeability.

Zinc for maintaining intestinal wall integrity and a healthy immune system.
Probiotics – Lactobacillus acidophilus (NCFM), Lactobacillus rhamnosus GG (LGG), Bifidobacterium lactis (Bi-07), Saccharomyces cerevisiae boulardii, Lactobacillus plantarum 299v. Remember that the gut is a numbers game, the higher the strength of you probiotic the better. Try Custom Probiotics CP-1 – it is around 98 billion bacteria per capsule.

 

Herbs

Anti-inflammatories: Matricaria recutita (chamomile), Glycyrrhiza glabra (licorice), Filipendula ulmaria (meadowsweet), Curcuma longa (turmeric), Boswellia serrata (boswellia)

Choleretics to increase bile secretion: Cynara scolymus (globe artichoke), Silybum marianum (milk thistle), Taraxacum officinale (dandelion), Curcuma longa (turmeric)

Carminatives to relieve flatulence and soothe intestinal spasm: Matricaria recutita (chamomile), Foeniculum vulgare (fennel), Cinamomum zeylanicum (cinnamon), Zingiber officinale (ginger), Citrus reticulata (chen pi), Mentha piperita (peppermint), Curcuma longa (turmeric)

Antacids: Filipendula ulmaria (meadowsweet)

Antiemetics to reduce nausea and vomiting: Zingiber officinale (ginger), Cynara scolymus (globe artichoke), Mentha piperita (peppermint)

Bitter tonics to improve appetite and digestion: Artemisia absinthium (wormwood), Gentiana lutea (gentian), Taraxacum officinale (dandelion)

Demulcents to soothe the mucous membranes of the digestive tract: Glycyrrhiza glabra (licorice),   Trigonella foenum-graecum (fenugreek), Althaea officinalis (marshmallow root), Ulmus rubra (slippery elm)

Spasmolytics to reduce or relieve smooth muscle spasms: Matricaria recutita (chamomile), Foeniculum vulgare (fennel), Mentha piperita (peppermint)

Nervines and mild sedatives to decrease nervous tension when stress is involved: Scutellaria lateriflora (skullcap), Valeriana officinalis (valerian), Matricaria recutita (chamomile), Melissa officinalis (lemon balm)