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A Healthier Holiday: Managing Digestive Issues

November 17, 2015 10:00 AM with Dr. David Labowitz

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Many of us spend the holiday season cooking and enjoying special meals, treats and desserts around the table. For those who live with common digestive issues, such as GERD, celiac disease or acid reflux, paying attention to what you eat during this time of year is crucial. Not sure where to start? Join Dr. David Labowitz, NorthShore Gastroenterologist for a chat on making the right choices for your digestion during the holidays. Learn about different food options for your conditions, what to avoid and ways to manage your symptoms if they occur. Submit your questions now.

  Kathryn (Moderator) - 10:00 AM:
Our digestion chat is now open. Please feel free to submit questions at any time during the chat.

Dr. David Labowitz (NorthShore) - 10:00 AM:
I would like to thank everyone for coming to this interactive question and answer session. The point of this talk is to provide patients with insight into different behavioral and nutritional triggers to GI related issues. For the sake of complexity, we have opted to concentrate on reflux, celiac disease and IBS. Given that GI symptoms often accompany the holidays, we want this talk to specifically hone in on ways we can combat these annoying symptoms during this wonderful time of year. I will do my best to answer all your questions providing as much insight and information as I can. I would urge everyone not to substitute this question and answer period for actual medical advice or care. I tell patients all the time that dealing with GI symptoms is sometimes more of an art than a science. There is not a one size fit all solution. Suffice to say, if you have any abnormal or persistent symptoms, please see a GI doctor or your PCP.

  Marie (Skokie, IL) - 10:03 AM:
What are some of the not-so common symptoms of GERD? For example, I have heard that excessive dry cough can be a sign of GERD; is this true?
Dr. David Labowitz (NorthShore)
Thank you for the great question. The answer is yes. Now, let me explain. I break symptoms of reflux down into two categories. The first set of symptoms I categorize as typical or esophageal symptoms. These include heartburn, upper abdominal pain and indigestion. These are the traditional symptoms associated with reflux. However, reflux is when contents from the stomach flow back up into the esophagus. This can also flow back higher, affecting the throat region, lungs and larynx (voicebox). So a second category of symptoms are the atypical or extra esophageal symptoms. These include a brash taste in the mouth, throat irritation, hoarseness, and cough. So to answer your question, reflux is in the differential for a patient with a persistent excessive dry cough.

  Kedpol (Schaumburg,IL) - 10:10 AM:
Can spicy ingredients like hot peppers cause GERD?
Dr. David Labowitz (NorthShore)
Great question. Spicy foods are always at the top of the list of triggers that people report for their reflux symptoms. Most doctors recommend patients with heartburn stay away from spicy foods (especially if bothersome to them when eaten). Thereby, an important take home message is if there is a food that bothers you, whether causing you upper abdominal pains or heartburn, you should avoid it. However, the answer to this question is a bit more complicated. Reflux is caused when the muscle at the end of the esophagus (called the lower esophageal sphincter) opens, allowing contents from the stomach to flow back up. In studies that have looked at what weakens this muscle, spicy foods have NOT been found to be responsible. However, they definitely irritate people's stomachs, and if the lower esophageal sphincter muscle is weak at the time the spicy foods are eaten, they definitely can irritate the esophagus as well (causing heartburn and indigestion). So, avoid foods that bother you!

  Karen (Evanston, IL) - 10:19 AM:
What should I consider when selecting an over the counter medication for heartburn?
Dr. David Labowitz (NorthShore)
Great question. The over the counter (OTC) meds work by neutralizing or blocking the acid production inside the stomach. They do not stop the backflow of material up into the esophagus. They simply change the acidity of the stomach. Antacids are first line OTCs. They provide immediate relief by soothing minor heartburn by neutralizing stomach acid. They typically contain bicarbonate salts. The next set of medications are the H2 blockers. These medications work by blocking histamine which is an important stimulator of acid production. They are typically very good at treating heartburn, but if there is inflammation of the esophagus, they tend not to work as well. The next category of medications are the proton pump inhibitor's. These medications directly block the acid producing pumps in the stomach. They are more effective than the H2 blockers. They are not great on- demand medications. Deciding which medication to use depends on the nature, severity, and frequency of symptoms.

  Ray (Skokie, IL) - 10:29 AM:
Does stress contribute to GI related issues?
Dr. David Labowitz (NorthShore)
Great question. Yes, stress definitely plays a role in GI symptoms. We have to remember that the intestines have their own nervous system that talks with the brain. So we often manifest stress through GI symptoms. I often use a GI psychologist in my practice to help better manage stress and anxiety, and thus improve GI symptoms. As far as reflux, stress has been shown to weaken the muscle at the end of the esophagus, leading to the backflow of stomach contents. Stress control or relaxation is a great way to help symptoms during the holiday season.

  Trina (Mt Prospect, IL) - 10:39 AM:
One of my relatives has celiac disease, and I’m trying to make some options that will be healthy for them for our big dinner – are there veggies that bother people with gluten issues?
Dr. David Labowitz (NorthShore)
Thank you for asking this great and timely question. People with celiac disease cannot have gluten, which is in wheat, barley and rye. Vegetables are safe. However, the sauces that are added often may contain gluten. If you simply steam, broil, grill the vegetables (on a clean surface) then you should be safe. However, celiac patients can have turkey but should avoid traditional stuffing. There are many gluten free recipes and websites that can assist you.

  Kenny (Elk Grove, IL) - 10:44 AM:
Are alcohol and caffeine irritants similar to spicy foods or would they be more serious contributors to GI problems?
Dr. David Labowitz (NorthShore)
Great question. Alcohol and caffeine impact GI symptoms, expecially in reflux. These both have been shown to weaken the muscle at the end of esophagus, leading to reflux symptoms. If one suffers from heartburn, it is a great idea to avoid both caffeinated products and alcohol. As far as other GI symptoms, caffeine has also been shown to increase intestinal motility, leading to looser stools. As far as them being an irritant, I would advise anyone who gets symptoms after taking in alcohol or caffeine to simply avoid them. This is often a great tip to get patients through the holiday season.

  Monica (Park Ridge, IL) - 10:50 AM:
Are there any classic Thanksgiving dishes that you think should be avoided for those of us who have chronic stomach issues?
Dr. David Labowitz (NorthShore)
Great question. I can give some general guidelines but we need to remember that this is not a one size fit all solution. Here are some tips for getting through the holiday season. 1. Limit or avoid alcohol and tobacco. 2. Avoid caffeine 3. Eat small, frequent meals. When we have larger meals, they tend to take a longer time to leave the stomach (especially fatty foods) and can lead to more abdominal pains and reflux. 4. Stay way from peppermint products if your reflux is bad. 5. Do not lie down for 2-3 hours as this can worsen reflux symptoms. 6. Eat slowly. 7. Wear loose fitting clothing. Don't forget to enjoy yourself, too!!

  Catherine (Evanston, IL) - 10:56 AM:
I often experience bloating after big holiday meals – do you have any suggestions for how I can treat this?
Dr. David Labowitz (NorthShore)
Great question. Bloating is a very difficult symptom for both patients and physicians. Treating it is more of an art than a science. I typically take a long history from the patient, consider their bowel habits, other symptoms and dive into possible triggers. Improving things can take multiple visits. My best recommendation would be to track your symptoms and then discuss with a gastroenterologist. You can use some of the tips noted above to help as well. However, there are often other foods that we take out of the diet, which is a little too complex to discuss here.

  Kathryn (Moderator) - 11:00 AM:
This will be the end of our chat. Thank you for your questions! For more information on the conditions discussed today, or to schedule an appointment with a specialist, visit our Gastroenterology department.

Dr. David Labowitz (NorthShore) - 11:02 AM:
Thank you all for coming to this interactive talk. I wish everyone a happy and healthy holiday season. If you or anyone you know has persistent GI symptoms, please feel free to make an appointment with one of our GI doctors at 847-657-1900.

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