Expert tips for holiday feasting without the heartburn
Special foods are among the pleasures of holiday celebrations. On the negative side, for people with digestive diseases or those who overindulge, holiday feasting can quickly produce the food version of a hangover. James East, M.D., a gastroenterologist at Mayo Clinic Healthcare in London, explains why this sometimes happens and how we can enjoy the menu while also making holidays happy for our digestive systems.
Why indigestion and heartburn happen
Indigestion, or an upset stomach, can be caused by overeating; eating fatty, greasy or spicy foods; consuming too much caffeine, chocolate, alcohol or carbonated beverages; smoking; anxiety and certain medications, such as some antibiotics, pain relievers and iron supplements.
It also can be a symptom of an underlying digestive disease, such as pancreatitis, celiac disease, irritable bowel syndrome or gastritis.
While indigestion involves discomfort in the upper abdomen, heartburn is a pain in the chest behind the breastbone.
"Heartburn is caused by acidic stomach content moving into the esophagus, or gullet, which is much less resistant to acid," Dr. East says. "This results in irritation and damage to the lining of the esophagus, literally a burn, that causes pain."
Like indigestion, heartburn can be caused by large, fatty, greasy or spicy meals, chocolate, alcohol, carbonated beverages and caffeine. But the list of foods linked to heartburn is longer: Onions, citrus fruits, tomato-based foods and peppermint are among the additional culprits.
Chronic heartburn is known as gastroesophageal reflux disease.
"The ring of muscle at the bottom of the gullet usually squeezes tightly except when we swallow food; however it can get weaker with age, or disrupted if patients develop a hiatal hernia," Dr. East explains. "Conditions that slow gastric emptying, such as gastroparesis, or increase pressure within the abdomen, such as obesity or pregnancy, also can make reflux more likely."
Other ways food can irritate the digestive system
Holiday foods that seem benign can pose hazards for those with digestive diseases, Dr. East says.
For example, dairy products, alcohol, caffeine and large meals can make people with inflammatory bowel disease feel worse.
Sticky foods such as peanut butter and caramel, thin liquids such as coffee and juice, and alcohol, caffeine or large meals can prove difficult for people with swallowing disorders, known as dysphagia. A menu lacking fiber such as those heavy in processed foods, meat, dairy products can make chronic constipation worse.
Avoiding raw fruits and vegetables, carbonated drinks, alcohol and large meals is recommended for people with gastroparesis, a motility or food movement disease that slows or stops the stomach's ability to move food through the digestive tract.
Preventing digestive discomfort
"Lower-fat food options are helpful for many digestive diseases, as are nonalcoholic beverages," Dr. East says. "Decaffeinated beverages are helpful for some patients, as is a reasonable level of portion control so that guests don't feel pressured into overeating."
Taking antacids or even acid suppressing drugs, such as omeprazole, preemptively can reduce symptoms but should not be an excuse to overindulge, he says: Although these medications reduce acid, they do not help with the volume or regurgitation component of reflux, so overeating can still lead to uncomfortable symptoms.
"Moderation in both food and alcohol and enjoying the range of dishes available from your host is a better strategy than additional medication," Dr. East says.
Taking steps to cope with anxiety and stress is also important.
"Anxiety and stress play a major role in gastroenterological symptoms, especially irritable bowel syndrome, which is a disorder of the brain-gut axis," Dr. East says. "Our brains and gut have very dense neural connections and being stressed or anxious can lead to gut nerves being oversensitive where they fire off pain signals, such as cramping or bloating, at much lower levels of stimulation than would normal be required, known as visceral hypersensitivity."
Techniques to reduce stress and anxiety such as mindfulness, cognitive behavioral therapy or hypnotherapy can help, he says. Physical positioning also plays a role.
"Classical triggers for reflux include a large fatty meal late in the day, with alcohol, and then lying down flat," Dr. East says. "To avoid heartburn, we should do the opposite and have our main meal in the middle of the day, not eat within three hours of bedtime, avoid fatty foods, moderate alcohol intake and consider raising the head of the bed."
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