Dr. Andy Tau for MedShadow Foundation Article
1. How do you know if your digestive tract is functioning well?
A well-functioning digestive tract is typically indicated by regular bowel movements, the absence of gastrointestinal symptoms such as bloating, pain, or excessive gas; and the ability to digest and absorb nutrients effectively.
2. Why is healthy digestion important for overall health?
Healthy digestion is crucial for overall health as it ensures the proper absorption of nutrients, supports the immune system, and maintains the balance of the gut microbiome, which is linked to various aspects of health including defense against infection and metabolic function.
3. What digestive disorders do you most often see in your office? Can you describe them?
Common digestive disorders seen in clinical practice include irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and functional dyspepsia. IBS is characterized by abdominal pain and altered bowel habits without any identifiable organic cause. GERD involves the reflux of stomach contents into the esophagus, causing symptoms like heartburn and regurgitation. Functional dyspepsia presents with upper abdominal discomfort or pain, often related to meals, without an identifiable structural cause. More serious conditions like inflammatory bowel disease (ulcerative colitis and Crohn’s disease) are also seen and manifest with bloody bowel movements, diarrhea, abdominal pain, and/or severe urgency.
4. This article will focus on common medicines for digestive problems, their benefits, and their long-term side effects. Can you discuss the benefits/risks of these medications?
- Antacids: Provide quick relief by neutralizing stomach acid but can cause constipation or diarrhea depending on the formulation and are very short-lived in their benefit.
- Proton Pump Inhibitors: Effective for GERD and peptic ulcers but long-term use is associated with risks such as mild nutrient malabsorption and increased susceptibility to infections. They also have a profound rebound reflux phenomenon if stopped abruptly and thus should be tapered off when the decision is made to stop this class of medication.
- Histamine Blockers: Useful for reducing stomach acid, especially as an on-demand medication, but may have limited efficacy and potential for tolerance development.
- Promotility Agents: Improve gastrointestinal motility but can have side effects like diarrhea and, in some cases, cardiovascular risks (e.g., tegaserod).
- Laxatives: Effective for constipation but in large quantities can cause electrolyte imbalances and dependency on long-term use (Senokot).
5. What are the best practices for keeping your gut healthy?
Best practices for maintaining gut health include a balanced diet rich in fiber, regular physical activity, adequate hydration, and stress management.
6. Are there any supplements you recommend?
Regarding supplements, probiotics and prebiotics are often recommended to support gut health. However, their efficacy can vary, and it is essential to choose products with well-documented strains and dosages.
Probiotics and prebiotics currently are not one-size-fits-all, as the right choice is likely bespoke to the patient’s individual gut microbiome population. Currently, doctors lack highly sophisticated tests to predict and choose the exact probiotic strain that will be most effective for any given individual, but active research in this area is ongoing, particularly with the advent of artificial intelligence/machine learning.
7. Why are digestive issues and the use of digestive medication on the rise in the US?
Likely the rising interest and awareness of the microbiome and specifically suggestions in medical literature that probiotics may correct the imbalance or “dysbiosis” that may be associated with antibiotic use and GI symptoms. Also, the increased incidence of anxiety/depression and mental health issues after the COVID-19 pandemic may have increased the manifestation of disorders of the gut/brain interaction which are associated with concomitant anxiety/depression (ie irritable bowel syndrome, functional dyspepsia).
8. Can digestive medications ever cause other digestive issues? Is there any danger in over-medicating for digestive issues (specifically readily available OTC products)?
Yes, there are many examples:
- Excessive use of magnesium supplements can cause diarrhea.
- Senna for constipation can lead to dependence.
- Some probiotics may lead some individuals to have more bloating (not one size fits all).
- Large quantities of soluble fiber can create gas. It is best to gradually increase intake over time.
- Overuse of Pepto-Bismol will cause stools to become black which can be confusing as black stools can be a sign of upper GI bleeding.
- Overuse of any laxative obviously can result in excessive diarrhea leading to dehydration.
