Dealing with Digestion

Some may refer to it as a sweet disease because of its link to high sugar levels, but diabetes is definitely not what you would call a ‘sweet deal’.

Complaints relating to digestion are very common. Indeed, community-based studies have shown that up to 53% of people complain of digestive symptoms such as bloating, dyspepsia or constipation at one time or another. From merely being irritating and disruptive to our lifestyle to being signs or symptoms of a more serious medical condition, digestive health issues are varied. Thus, it is good for us to pay more attention to our digestive health. At the very least, we can improve our overall health and wellbeing.

Many Malaysians tend to have poor dietary habits that have a detrimental impact on a healthy digestive system, such as irregular meals, and consumption of food high in sodium and saturated fats. They also tend to ignore warning signs such as weight loss and appetite loss. Another practice that should be discouraged is the belief in medications or supplements to boost appetite when no such safe and proven medications exist in the market currently.

What is digestion?

To better understand digestive health, let us take a look at the process of digestion. Digestion is the complex process of turning the food you eat into nutrients, which the body uses for energy, growth and cell repair needed to survive. The digestion process also involves creating waste to be eliminated. The digestive tract starts at the mouth and ends at the anus, and involves many organs and parts of the body, including the mouth, esophagus, stomach, liver, gallbladder, pancreas, and intestines.

Common complaints

Our digestive system works hard every day, and for some people, they face discomfort as often as every day. Common complaints include dyspepsia – a feeling of fullness during a meal, uncomfortable fullness after a meal, and burning or pain in the upper abdomen; gastro-esophageal reflux (GERD), a physical condition in which acid from the stomach flows backward up into the esophagus; as well as constipation. The root of these complaints are varied, from physical causes such as the valve between the esophagus and the stomach not working properly and allowing stomach acid to leak upward; to triggers such as medications and bacteria like Helicobacter pylori (H. pylori); or simply the lack of sufficient fluid and fibre intake.

Beyond these, there are also common digestive diseases in Malaysia that we should pay attention to. Among these are Irritable Bowel Syndrome (IBS) which happens when our intestinal muscles go haywire and cause a long and varied list of symptoms such as chronic constipation often alternating with diarrhoea, gas, bloating, cramping and a feeling that you haven’t gotten everything out; haemorrhoids or piles – swellings that contain enlarged blood vessels that are found inside or around the rectum and anus, inflammatory bowel diseases such as Crohn’s Disease and Ulcerative Colitis when the immune system turns on itself, resulting in chronic inflammation, scarring and blockage; peptic ulcers – painful sores or ulcers in the lining of the stomach or first part of the small intestine; and lactose intolerance that causes cramping, bloating, gas, nausea and diarrhoea 30 minutes to two hours after drinking or eating a dairy product.

One very serious condition also considered a common digestive disease is colon cancer, the 2nd most common cancer in the Malaysian population with a lifetime risk of 1/40 in males and 1/60 in females. Symptoms of colon cancer include blood in stools, bleeding from the back passage, severe loss of weight and in some severe cases, blockage of the bowel which may present with severe abdominal pain and vomiting. In earlier stages, these symptoms may seem similar to other conditions. Like many other cancers, we are encouraged to reduce risk factors where possible, in this case, eating less red and processed meats, exercising and maintaining a healthy weight, avoiding smoking and excessive alcohol consumption, and to also go for screening in order to detect the cancer when it is most treatable.

Managing digestive health

Digestive health complaints can be reduced by watching our diet. In many cases, it is advisable to cut down on coffee, tea, chocolate, carbonated drinks, spicy foods, fatty foods, alcohol, dairy products and tomatoes, which can provoke or worsen reflux, dyspepsia and lactose intolerance. Eating smaller meals and not rushing through meals can help, as well as taking walks after meals. Likewise, more fluid and fibre in the diet helps constipation, while removing all foods and conditions that trigger irritation can alleviate irritable bowel syndrome (IBS). Other than treating conditions like peptic ulcers and haemorrhoids, prevention is also important. For haemorrhoids, this usually means addressing the causes of constipation while lifestyle changes may prevent further peptic ulcers. For chronic conditions such as Crohn’s Disease and Ulcerative Colitis, specialist help should be sought and it can be mostly controlled with medication.

For a serious disease like colon cancer, smoking cessation is the most important factor for reducing risk. Exercise and a low-fat, high-fibre diet that includes at least five servings of fruits and vegetables each day is recommended as it may reduce risk. As with most health conditions, screening helps to detect colon cancer early, when it responds best to treatment. Get regular check-ups from your doctor, including a rectal exam, faecal occult blood test, and possibly other screening tests such as a barium enema, a flexible sigmoidoscopy, or a colonoscopy. Screening recommendations depend upon an individual’s risk of colorectal cancer. Be aware of your family history as colon cancer has been shown to run in families. If you are diagnosed with colon cancer, the type of treatment depends largely on the stage of your cancer. The three primary treatment options are: surgery, chemotherapy and radiation.

Symptoms of serious conditions

Sometimes, something that appears to be a digestive problem can be something else entirely. A burning sensation in the chest after a big meal may be heartburn, but there’s a chance the chest pain is caused by reduced blood flow to your heart (angina) or an actual heart attack. It’s advisable to call an ambulance or go to the emergency room if you have persistent chest pain and you aren’t sure it’s heartburn – especially if it is a new symptom which you have never had. From a muscle spasm in your esophagus to pain in the gallbladder, various conditions can feel like chest pain. If you are in doubt, it’s advisable to seek medical attention immediately.

Another cause for concern is blood in the stool – which can be anything from diverticular disease, anal fissure, colitis, angiodysplasia (abnormal blood vessels in the gastrointestinal tract), peptic ulcers, polyps or cancer, or haemorrhoids. You should always seek attention if you get blood in your stools for the first time.

Public misconceptions

As with many health matters, there are various public misconceptions on digestive health. This includes thinking all rectal bleeding is due to haemorrhoids when it could be colon cancer, believing that detoxing is required for a clean and healthy gut, believing that digestive health supplements such as fibre supplements and probiotics are superior to whole foods, or even that having regular bowel movements means at least one bowel movement a day.

Practical caution

Although digestive health issues are common, sometimes it is important to consult a doctor urgently. The best practice would be to seek medical attention if symptoms are persistent, new in onset and disrupting daily life. Also, if there are worrying symptoms like food getting stuck during swallowing, significant loss of weight and appetite, and blood in stools for the first time, medical advice should be sought early as these symptoms may be a signal that there is something more serious than just mild ‘indigestion’.