Digestive Health During the Holidays

The holidays are a time for family, friends – and food! For many people, the many celebrations and holiday meals can severely disrupt the digestive system, causing intestinal discomfort, acid reflux, indigestion, heartburn and more. Neha Sahni, MD, gastroenterologist with Rush Copley Medical Group, provided tips at a recent health talk to keep digestive health in check this holiday season.

Avoid weight gain

Holidays and weight gain often go hand in hand. To avoid gaining weight, caloric intake and energy expenditure should balance. Typically, individuals should consume between 2,000 and 2,500 calories a day, and Dr. Sahni suggests keeping a food diary to calculate intake. To make good choices, be aware of what constitutes a healthy diet. Macronutrients are foods our bodies need in large amounts. She says a healthy diet consists of three primary macronutrients: carbohydrates, proteins and fats. Fiber may also be considered a macronutrient.

Carbohydrates provide your body with energy and should account for 45 to 65 percent of total calorie intake, Dr. Sahni says, noting the type of carbohydrate is important. Whole grains are preferred over refined grains, and high glycemic index foods, such as white rice and pancakes, should be replaced with low glycemic index foods, such as fruits and vegetables. She explains that foods with a high glycemic index are quickly digested and absorbed, causing a rapid rise in blood sugar. Beverages and processed foods which have added sugars should make up less than 10 percent of total calories.

Make healthy choices

Proteins help build and repair tissue, bone, muscle, cartilage, blood, and skin and should comprise 10 to 35 percent of a person’s total caloric intake. Dr. Sahni recommends eating a variety of protein: fish, lean meat, poultry, eggs, beans, peas, nuts and seeds.

Fats should make up 20 to 35 percent of caloric intake, and the type of fat is important. Trans fats – found in margarines, processed foods, crackers, cookies and fast foods – are associated with coronary artery disease and should be kept to less than 10 percent of calories. Unsaturated fats are better choices as they reduce cholesterol, protect against illness and help maintain body temperature. These include avocado, peanut butter, nuts and seeds, fish oil and omega 3 fatty acids.

A daily diet should include 25 to 36 grams per day of fiber as it helps decrease coronary artery disease, stroke and colon cancer. Whole grains found in barley, oatmeal, brown rice, whole wheat breads and pastas are preferred over refined fibers, which include pasta and white breads and white rice.  

Alcohol and sweetened beverages

What’s a holiday celebration without a toast? Alcohol should be consumed in moderation, and Dr. Sahni advises no more than one drink per day for women and two drinks per day for men. Moderate consumption may decrease risk of coronary artery disease but increase the risk of breast and colon cancers. Soft drinks and sweetened beverages – including fruit drinks, sports drinks and energy drinks – should be limited as they contain added refined sugar and calories, contribute to weight gain and increase coronary artery disease, diabetes and hypertension.  Moderate consumption of coffee – three cups a day – may lower liver or uterine cancers. When drinking juices, Dr. Sahni recommends the kind with pulp for the fiber. Water is always a good choice.

Irritable bowel syndrome and the holidays

Irritable bowel syndrome, or IBS, affects 10 to 15 percent of Americans, but less than half are diagnosed. Symptoms include recurring gut pain or discomfort with diarrhea or constipation or both.  IBS is worse over the holidays because of unhealthy foods and stress. Cookies and pies contain artificial sugars which are not good for IBS and cause bloating. Stress increases cortisol which worsens symptoms and doesn’t allow food to digest properly.

Dr. Sahni recommends trying to stick to a routine over the holidays and asking about ingredients in cooked foods.  She also suggests people identify triggers for their symptoms. “If meatballs are a trigger, eat smaller portions or avoid them altogether,” she says. “If you are lactose intolerant, keep Lactaid tablets with you. Stay hydrated to prevent constipation. Know your body and don’t overdo it.” Her other recommendations:  stay away from caffeine and carbonated beverages (they cause gas and heartburn); drink herbal teas; don’t overeat (it takes four to five hours for food to go through the small intestine); use MiraLAX for constipation and Imodium for diarrhea. Diets low in FODMAPS are an effective therapy for IBS. This FODMAP list recommends which foods to eat and which to avoid if you suffer from IBS.

Avoid acid reflux

Acid reflux symptoms include a burning in the chest or upper abdomen, sore throat, belching, hoarseness and difficulty swallowing.  Large meals exacerbate symptoms so she recommends eating four to five smaller meals rather than two to three large ones. Other tips include losing weight and avoiding smoking and trigger foods like spicy and fatty foods, citrus, alcohol, onion, chocolate and caffeine. Do not wear tight clothes or lie down for three hours after eating. When going to bed, use pillows to elevate your head by four to six inches.

Do not use Zantac

Zantac, a drug commonly used to relieve and prevent heartburn, has been recalled and should not be used. Instead, Dr. Sahni says Tums or Pepcid can be used as needed. For more severe cases, Prilosec is available over the counter, but should be taken continuously for at least two weeks, rather than as needed.

Celiac disease

Holiday gatherings can be challenging for people with Celiac disease. Those with this immune disease cannot eat gluten – a protein found in wheat, rye and barley – because it damages the small intestine. Dr. Sahni recommends discussing needs with relatives beforehand and suggests that gluten-free guests should go through buffets first to avoid cross-contamination, take a dish to share with others, and bring a snack or eat before going to a party.

Helpful holiday tips

In general, Dr. Sahni recommends the following tips.

  • Be active, get plenty of sleep and control stress.
  • Snack wisely.
  • Watch portion sizes, use a smaller plate and practice mindful eating.
  • Bring a healthy dish to a potluck.
  • Limit desserts.
  • Weigh yourself daily.

With a little forethought and wise eating, you and your digestive system can enjoy the holidays!

Learning about Celiac

Celiac disease is an immune reaction to gluten, a protein found in wheat, barley, and rye.  The protein gluten can trigger an immune response in your small intestine damaging the lining.  With the loss of proper small intestinal lining,  this can cause symptoms such as diarrhea, fatigue, weight loss, bloating, and anemia.

Why does Celiac disease happen? The actual cause is unclear, but is seems to occur due to genetic and environmental factors.  If you have a first degree relative with Celiac disease, the risk of other family members to have Celiac disease is as high as 10 to 40%.  One percent of Americans have Celiac disease and 95% remain undiagnosed.

How is Celiac diagnosed? There are blood work and genetic tests that can be done to make the diagnosis. But the gold standard for diagnosis is an upper endoscopy in which a biopsy of small intestine is obtained for examination.  For an accurate diagnosis, the patient must be eating gluten for at least two weeks, otherwise the test results may be falsely negative. This is because, with a strict gluten free diet, the lining of the small intestine repairs and will appear normal.

What are the complications of Celiac disease? If one does not maintain a strict gluten free diet, the intestinal lining will remain damaged and absorption of nutrients will be affected.  Iron deficiency is something to look out for. With iron deficiency, one can become anemic.  Calcium and vitamin D malabsorption can lead to osteoporosis, as well as infertility and increased risk of miscarriage.  Damage to the lining can also affect the absorption of sugars, such as fructose, lactose, and sucrose.  People can have a greater risk of developing intestinal lymphoma and small bowel cancer.  Although rare, some people may develop disease of nerves to hands and feet.  One can also develop a rash and a blistering skin disease.

How to treat Celiac disease?
There is no cure for Celiac disease. Maintaining a strict gluten free diet is key to the management.  Common foods that contain gluten include: flour, breads, crackers, muffins, pasta, cereal, baking mixes, sauces, spices, condiments, salad dressings, some medications and vitamin supplements. Wheat additives are the most common additives in American food, thus making it very important to reading all labels and taking extra caution.  After remaining gluten free, one will notice improvement in symptoms within days or weeks. However it can also take up to two years for intestinal healing. Some patients may need medications for treatment of this condition.

Learn more about Celiac at https://celiac.org

Sports physicals: Schedule and score

The drone of a lawn mower, the warmth of the noonday sun, the smell of sunscreen and fresh cut grass – summer is here and now is the best time to schedule your child’s sports physical.  Completing the exam early in the summer allows plenty of time to follow up with a specialist, if needed, or complete any additional tests. It also prevents the rushed sensation that comes with putting off the sports physical until the day before tryouts or the first practice.

Whether you’re a seasoned veteran or a rookie, everyone can benefit from a refresher on what a sports physical includes and why they are mandatory.  A preparticipation physical evaluation, or PPE, is a great way to maximize safe participation in a sport as it can identify life-threatening medical complications as well as old injuries and conditions that may interfere with performance.

The medical history form is the most important part of a PPE.  Personal and family history and review of symptoms detect approximately 75% of conditions that restrict participation or require further evaluation.

The physical exam will include a height and weight measurement, vital signs, vision test, musculoskeletal exam and cardiac screening. Make sure your children bring their glasses or contacts for the vision portion of the exam. If any joint pain or issues arise on the physical exam, having a sports physical early in the summer allows time to formulate a plan of care emphasizing rehabilitation and injury prevention.

In addition to the PPE, parents are encouraged to schedule their student athletes for baseline ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) and Sway tests.  Done before the season begins, these tests offer baseline information which will assist practitioners in making decisions about return to play in the event of a concussion. These two tests are not covered by insurance.

Please remember, a sports physical is not a substitute for an annual exam.  It is very important to have an established relationship with a health care provider who will oversee your child’s care throughout the year.

Rush Convenient Care locations offer school and sports physicals. No appointment needed. Learn more at rushcopley.com/convenientcare.

Concussing Testing
Deepak Patel, MD, Rush Copley Medical Group family and sports medicine physician, offers ImPACT and Sway tests in Aurora and Yorkville.  The cost is $25 per test. To schedule an appointment call 630-236-4270.

Diet Therapy for IBS

Irritable bowel syndrome (IBS) is a chronic and complex disease that occurs in patients with recurring abdominal pain and changes in bowel habits. The disease can be debilitating on a person’s quality of life. We still do not understand the root cause of the disease, but I believe there are many factors. Common treatments of IBS include pharmacologic, psychologic and dietary therapies. It is important to discuss these options with your physician before embarking on a targeted therapy or combination therapies.

Some patients are interested in using diet alone to treat their illness. Aversion to pharmacologic agents and avoidance to see a psychiatrist or psychologist play a major part of this. Ingestion of food triggers may induce symptoms in more than half of patients with IBS. It has been suggested that dietary therapy may regulate the “gut-brain” signaling. Therefore, in my opinion, it is reasonable to start with dietary therapy to reduce this driving cause.  Clinical studies suggest that low FODMAP diet may improve symptoms of IBS. FODMAP stands for Fermentable Oligosaccharies, Disaccharides, Monosaccharides and Polyols. They are carbohydrates found in the diet: fructose (fruits, honey, high fructose corn syrup, etc), lactose (cow’s milk, yogurt, pudding, custard, etc), fructans (grains, onion, garlic, inulin, etc.), galactans (beans, lentils, soy products, broccoli, etc.) and polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol and fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc). FODMAPs can swell the intestine and produce gas. If one is sensitive to the effects of FODMAP, symptoms of discomfort, cramping, gas, bloating or diarrhea may occur. Low FODMAP diet may help improve pain, bowel satisfaction and quality of life. There are apps available on smart phones to help guide which foods are high or low in FODMAPs.

Some patients without Celiac disease may report a possible diagnosis of gluten sensitivity due to improvement of their symptoms while on gluten-free diet. The diagnosis of gluten sensitivity is quite challenging. The reason being is that there is no measurable indicator available to diagnose the disorder. Although there is good symptom response self-reported by patients, who are undergoing a gluten-free diet, researchers have suggested that this is likely due to reduction of fructans and other FODMAPs that may co-exist with gluten in wheat, barley, and rye. Therefore, evidence does not support a role for gluten-free as first line dietary therapy. More studies are needed to define the role of gluten-free diet in IBS and other gastrointestinal disorders.

It is also common for patients with IBS to embark on a restrictive diet to improve their symptoms. I also see this commonly done in patients with Inflammatory Bowel Disease or Functional Dyspepsia. A major concern for this is that restrictive diet may lead to nutritional deficiencies and/or weight loss that can result into worse health outcomes. Therefore, I do not recommend this dietary approach without a proper discussion and guidance with a dietitian.

A low FODMAP diet, supported by growing body of evidence, is effective in IBS but should be delivered by healthcare professionals with expertise in diet management. Further studies are also needed to prove the effectiveness of a gluten-free diet, lactose restriction or probiotics in the treatment of IBS.

Learn more about Dr. Pacana’s approach to caring for patients and schedule an appointment at www.rushcopley.com/pacana

Colonoscopy: Have No Fear

Colonoscopy is a test use to examine the lining of large bowel or colon. The instrument has a light source, and a lens attached to a video monitor. The test is used for colon cancer screening and for diagnosis of various other diseases involving the colon in patients who may have bowel symptoms like bleeding or diarrhea.

Is the test as bad as it sounds? The answer is no. Fears and misconceptions persist like “will I be able to drink the prep”, or “it may hurt”, “complication may occur”, “I am not the one who will get colon cancer.” The fact is, colonoscopy is one of the safest procedures performed by a gastroenterologist.

Each year, 150,000 new cases of colon cancer are diagnosed and 50,000 people die from it. 60% of these lives can be saved by increasing awareness for screening of colon cancer. Colonoscopy not only helps detect precancerous growths called polyps but also gives the ability to remove them there and then. This prevents colon cancer in future.

Colonoscopy may be inconvenient but it’s not painful. It takes less than 45 minutes and you are sedated during this time. Colon prep these days are split into two halves, first half is taken the night before the procedure and the other half in the morning of the procedure, making it tolerable. In fact, lower volume prep solutions are also available these days.

Chances of someone having colon cancer over their lifetime is 1 in 20 which is high. This can be prevented by timely screening. Bottom line is, do not skip out on screening. Although colonoscopy is one of the most accurate test for colon cancer screening, there are other stool based tests which you may qualify for. So, talk to your doctor and get screened today.