Mr. Khalid is a Pakistani middle class ‘work your hind off’ day and night person who has to make provisions for his family. He works in a bank, has crazy work hours, hardly gets time for proper meals, and is worried sick most of the time about what’ll befall him and his family in the future.
Khalid has a constant sensation of fullness in his belly, a sour irritating taste in his mouth, mostly in the morning. The fullness makes him skip the afternoon meal/lunch. But he does take tea from the local tea club at the bank, one to two times during his working hours. Usually, he skips breakfast at home to grab a small pack of biscuits on way to work as he feels a discomforting full sensation in his belly early in the morning which makes him skip a reasonable breakfast.
The constant public dealing at work does take a heavy toll on Khalid. He gets agitated at times, feels jittery on most occasions, feels his heart racing all the time, with a tendency to lose his cool at the smallest of altercations. It’s 6 pm and he takes off from work. All worn out, physically and mentally exhausted. Constantly thinking about his deadlines for the next day and beyond.
While all this goes around in his head, he reaches home. Takes some tea and pain-relieving med to get riddance from the throbbing headache. Gets a shut-eye, wakes up and while his family enjoys dinner, he feels lost somewhere in his head. A realm of repetitive thoughts of relentless ensuing deadlines, financial matters, and pending domestic matters. He eats a small portion of food and throws his body like a sack of potatoes on the couch to watch some prime time news. The heated debates on TV trigger his adrenals to constantly pump adrenaline into his system while the doom and gloom on the tube give him butterflies in his tummy. His family notices him snoring half an hour into his ‘Prime Time Entertainment’ session. The wife nudges him and tells him to retire to his bedroom and rest.
Day in and out Khalid is on a repeat mode. His life entangled in a web of persisting stress, urgency, and inattention to his lifestyle. One day he discusses with his wife that he feels nauseous most of the time. Does not feel like having a meal portion beyond what might be considered appropriate for a kid. Feels bloated, has excessive belching, and passes a lot of flatus. He feels all this has affected his sleep quality and quantity, sometimes staying up all night. With some nights spent ‘consulting’ online search engines about his symptoms. The couple decides to consult their local General Physicians, homeopaths, and Herbalists ( turn by turn and simultaneously like a pinball in a pinball machine. He is given loads and loads of medication which is supposed to reduce the ‘Gas’ but it returns as soon as he stops the drugs.
Mr Khalid feels hopeless. He feels the ‘Gas’ is responsible for all the body pains, headaches, and joint pains he has been having. His almost mystifying and cryptic description of how the ‘Gas’ seeps through his stomach into his veins and ending up in his head, baffles all and sundry.
His life is held hostage to the sinister ‘schemes’ of this Diabolical Gas.
What this condition is and what Mr. Khalid needs to do?
In continuation of Part I, I will go through the actual basis of what Mr. Khalid is facing. It is an entity which in medical terminology is a ‘Functional Gastrointestinal Disorder’ or ‘Gas’, ‘Indigestion’, and ‘Bloating’ in layman terms.
I will briefly go over the workings of this ‘Diabolical’ ailment which has been a sort of conundrum for Physicians since time immemorial. Let’s begin with the goes behind all this.
Table of Content
THE AXIS
The brain is a mysterious supercomputer of sorts. Is powerful in controlling the functions of the body, involuntary & voluntary. From controlling our racing heart in face of fear to regulating our bowel movements, it is the Master. The connection between the brain and the gut can be called the ‘Brain-Gut’ axis. It is a ‘2-way’ communication pathway. The Gut has a ‘mini-brain’ of its own which has a complex interplay between hormones, nerve endings, gut secretions, and food. In other words, the Gut has autonomy but has a ‘Master’ overlooking it and intervening at every instant ( poor ‘mini-brain’).
The brain prepares the gut for food even when it’s not actually ingested ( drooling from the mouth & growling in the belly at the sight/smell of food). This shows a lot as to how what we think and feel determines how our gut functions. When we eat food, local factors in the gut along with our ever controlling brain control the digestion of food.
HORMONES, FOOD, AND GUT BACTERIA
The type of food we eat determines how long it will take to be digested and how much stomach acid and gut secretions will be produced in response to it. For example, protein in food can cause the release of a hormone called CCK in the gut which causes the stomach to release Hydrochloric acid (HCL) and if taken in excess ( protein) can cause bloating & heartburn. Fat in the food can cause delayed stomach emptying and a sensation of bloating. The gut is studded with nerve endings or sensors. These sensors form a mesh in the wall of the gut. These sensors receive information and send them to the higher control center in the brain.
So, you can connect the dots when someone says that a particular person has a very ‘sensitive’ digestive system. This has a scientific basis. The gut reacts differently to different stimuli in different people. Mental/Physical stress may not have any Gastrointestinal symptoms in some but can cause a wide array of symptoms in other much ‘sensitive’ people with the so-called ‘sensitive’ guts. From having abdominal cramps to constipation to diarrhea in times of stress, such people can have a mixed bag presentation.
Our Protagonist (Mr. Khalid) in part I is a stereotype of the hard-working, stressed & anxious people around us. Their gut movements/digestion is all messed up due to the mental and physical stress that they are facing in their lives. From erratic food intake behavior to unhealthy choices of food. It’s all there in these people. Our society and its pressures push people towards the brink of becoming the finicky ‘Type A personalities’. These are extremely irritable, anxious & apprehensive people are their guts are not any different. This is the very reason why just prescribing anti-secretory medication isn’t enough to control the symptoms in these people and they continuously move from one doctor to the next with this ‘diabolical’ gas issue to find no solace.
You will be surprised to know that the human gut contains more bacterial genes than the whole human genome. This speaks volumes about the purpose of these ‘critters’ in our digestive system. These microorganisms play a vital role in the digestion of nutrients and newer research has shown that a healthy ‘Microbiome ( the whole bacterial population in our gut)’ has a role in preventing chronic system diseases like Diabetes Mellitus, Hypertension and Hyperlipidemias by reducing inflammation. So, an altered Microbiome can cause a whole host of problems like indigestion in the short and long terms, even possibly Diabetes Mellitus in the long run. The Microbiome can also alter our mood and cognition. Processed food and injudicious use of antibiotics can play a detrimental role in altering our gut microbiome.
In the previous two parts, I and II mentioned the symptomatology and basis of it all respectively. Let’s move on to the solutions now.
One thing which I want to underscore before moving on to the actual crux is that there is no ‘one size fits all’. Everybody has different lifestyles, food likes and dislikes, habits, and basically different ‘Personalities’ and ‘Guts’ per se.
It’s not rocket science which can help us tackle this issue which most of us will face many times in our lives. Some basic adjustments when practiced with persistence can reap dramatic benefits. I will outline the basics here.
FIXED MEAL TIMINGS/APPROPRIATE FOOD ETHICS
- Don’t skip meals
- Always have a substantial breakfast, it determines how you feel throughout the day.
- Don’t eat in a hurry. Chew your every bite many times before you swallow because if you don’t then your gut has an uphill task to digest the food and will stay longer in your belly.
- It is advisable to eat the LEAST at dinner time so that you don’t feel stuffed and full before sleeping.
- Avoid spicy and fatty food.
- Stay away from refined carbs food ( bottled juices, white sugar, sweets, white flour)
- If you feel milk is causing you trouble, avoid it, or opt for a Lactose-free option.
- As mentioned in the previous part, certain veggies are known to cause bloating. Cruciferous veggies like cauliflower & cabbage, onions, and beans should be consumed in fewer amounts if you feel they are part of the problem.
- Cut down on the coffee & tea and also other caffeinated beverages.
GOOD QUALITY AND QUANTITY OF SLEEP
Unrest and lack of good sleep mess up with our digestive system and can cause a whole complex of symptoms like bloating, nausea, constipation, or/and diarrhea. Adequate hours of unbroken sleep should be at least 6-8 hours/day.
UNDUE STRESS, ANXIETY & DEPRESSION
Leave your work issues behind at work and try not to be pre-occupied with the ongoings all the time. Excessive worrying about domestic and work issues can wreak havoc on our biological system. Take up stress-relieving activities at home or outside, pick up hobbies, work out. If you feel that the stress, anxiety, and depression is getting better of you it’s better to get a Psychiatric consult.
ANTI-SECRETORY & OTHER MEDICATION
You might be wondering why I put this down the list. This is to emphasize the reality that Gastric dysmotility treatment depends on a whole host of underlying factors and not just drugs. This is why our ‘Protagonist’ in Part I was not getting any relief running from one clinic to the next with relapsing of the symptoms when the meds were stopped. Which is why many such patients remain on these medicines for years and years. Medications don’t come without a catch. And in the long run, anti-secretory meds can suppress your acid levels to very low or negligible levels which can hamper the barrier protection which HCL provides, and secondly acid is required for making iron in our diet ‘absorbable’. So, when HCL is not there, iron is not absorbed as it should lead to iron deficiency and anemia. Other drugs called prokinetics cause emptying of the stomach and these are another class of drugs that are abused by a lot of people for years and years. They also can cause many side effects with tremors in the hands and raised prolactin levels( a hormone ) in the blood.
HELICOBACTER PYLORI INFECTION OF THE STOMACH
A bacterium called H.Pylori can cause a state of inflammation in the stomach lining and contribute to chronic symptoms of bloating, heartburn, and abdominal pain. Physicians will screen Functional Gastric Dysmotility patients for this bacterium and treat it if present with antibiotics + anti-secretory medication which can lead to the resolution of symptoms.
ROLE OF COGINITIVE/BEHAVIORAL THERAPY
As previously mentioned, this ailment has a lot to do with the way we perceive the stresses in life and how we respond to them. In cases where patients do not respond to conventional treatment and lifestyle modification and suffer from symptoms of irritable bowel syndrome as well, cognitive or behavioral therapy can work. This therapy is provided by Psychologists who teach the patients techniques to counter stress, feel calm, and to be at ease with to cope with these changes in their bodies which are causing the symptoms. Repeated sessions can do wonders.
MISCELLANEOUS FACTORS
- Avoidance of smoking and alcohol consumption
- Avoid unnecessary use of painkiller medication and antibiotics
In a nutshell, it is not easy to approach this seemingly harmless & benign disease. It is a complex whole and should be dealt with ‘holistically’. Only this approach can permanently get rid of this FUNCTIONAL GASTRIC DYSMOTILITY. It’s easier said than done. But we can give it our best shot. It depends on solid teamwork between the Health Care Providers and their patients to improve the latter’s quality of life.
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