bloated? gassy? Want to be rid of stomach aches for good? Don’t eat. Don’t stress. Don’t drink. And hope no one in your family has a history of tummy trouble. Fortunately, you don’t need to go to such extremes to feel better. The ﬁrst step: Make an appointment with your doctor. Sounds obvious, but “some women don’t bring up their stomach problems during ofﬁce visits because, frankly, they ﬁnd them quite embarrassing,” says Dayna Early, a gastroenterologist at the Washington University School of Medicine in St. Louis, USA. Next, examine your lifestyle. And if lifestyle changes don’t help, medication often does. “There’s no need for women to suffer,” Early says. Here, leading gastroenterologists tell you what can be done to soothe that ailing tummy. ➤ By Hallie Levine Photography by Justin Loh 52 | live healthy | SHAPE August 2006 ART DIRECTION LINDA TOM STYLING CARRIE TAN HAIR & MAKEUP DENNIS EE (HP 9856-8293) MODEL CAROL, MANNEQUIN OUTFIT FLASH & SPLASH 8 reasons your stomach hurts and how to feel better fast. Even if you’re lactose intolerant, you may still be able to indulge in yogurt and hard cheese which are easily broken down by the body. SHAPE August 2006 | live healthy | 73 1 ● you’re popping over-the-counter remedies, instead of watching what you eat. Everyone takes the occasional Tums, but if you’re downing over-the-counter acid blockers morning, noon and night, you may have gastroesophageal reﬂux disease (GERD), a chronic condition caused by stomach acid that moves from the belly to the oesophagus. This is usually a result of weakness in the muscular valve that separates the stomach and the esophagus. The ﬁrst step towards getting healthy involves making lifestyle changes such as watching what you eat. Speciﬁc foods — namely citrus fruits, tomatoes and tomato sauces, chocolate, wine and caffeinated beverages — can trigger GERD. Your doctor may also have you keep a food diary for two weeks so you can pinpoint the foods that are giving you problems, adds Roshini Rajapaksa, a gastroenterologist at the New York University School of Medicine. One tip: Fill up on ﬁbre-rich foods like fruits, veggies and whole grains and limit saturated fat. A Baylor College of Medicine study found that those who ate high-ﬁbre diets (at least 20 grams a day) were 20 per cent less likely to suffer from GERD. As well, those with a diet low in saturated fat also cut their odds. 2 ● you’re stressed beyond belief. Making lifestyle changes like eating a high-ﬁbre diet can help keep stomach problems at bay. People who eat high-ﬁbre diets are 20 per cent less likely to suffer from chronic heartburn. 3 Ever wonder why you have to make frequent runs to the bathroom when you have a tight deadline at work or when you’ve just had a ﬁght with your husband? When you’re frazzled, elevated levels of stress hormones activate the normal contractions in your stomach and colon, causing them to go into spasms, says Patricia Raymond, a GI doctor at Eastern Virginia Medical School in Norfolk, Virginia. Stress hormones can also contribute to the overproduction of stomach acid, making you more susceptible to GERD. On top of that, stress often leads us to make poor food choices which can cause constipation and even more bloating. When you know you’re going to have a tough day, plan to eat small meals regularly so you’re not too hungry or full, and avoid overindulging in caffeine, 54 | live healthy | SHAPE August 2006 all of which can trigger an upset stomach. And get moving: An aerobics workout (aim for at least 30 minutes) will not only help you destress, it’ll also combat constipation by speeding up the movement of food through your digestive tract, says Raymond. ● you’ve got a bowel that’s easily irritated. If you’ve had intestinal pain for more than three months, you may have what’s known as irritable bowel syndrome (IBS). The problem affects about one in ﬁve women and is characterised by bloating, gas and alternating bouts of diarrhoea and constipation that are brought on by anything from dietary changes to stress. Ask your doctor about the IgG antibody test, a blood test that helps A British study found that IBS symptoms improved by 26 per cent when trigger foods were eliminated. pinpoint particular food sensitivities, suggests Mark Hyman, author of Ultrametabolism (Scribner, 2006). A British study found that eliminating foods from your diet improved symptoms by 26 per cent. “Other studies show that peppermint-oil capsules, available at health food stores, relieve IBS symptoms by relaxing the colon,” adds Michael Cox, a gastroenterologist at Mercy Medical Center in Baltimore. Look for “enteric coated” pills which break down in the colon, not in the stomach where they can cause irritation. Moderate symptoms should see an improvement with these two strategies. For more severe cases, your doctor may prescribe Zelnorm, a medication that regulates the movement of stool through your bowels, and suggest dietary changes and relaxation techniques like yoga. ● you’re lactose-intolerant. FOOD PHOTOGRAPHY ALVINN LIM & DARREN CHANG STYLING JUDY WANG 6 About one in four women have trouble digesting lactose, a sugar found naturally in dairy products like milk, ice cream and soft cheese. If you suspect that your gas or bloating is a result of lactose intolerance, cut out dairy products for a few weeks to see if symptoms improve, suggests John Chobanian, a gastroenterologist at Mount Auburn Hospital in Cambridge, Massachusetts. Still uncertain? Ask your doctor about the hydrogen breath test, where you blow into a bag after downing a lactose laced drink. High levels of hydrogen indicate you’re intolerant. Even so, there’s no need to give up dairy products. Yogurt and hard cheese are the easiest for your body to break down. Yogurt contains enzymes that help you process the lactose while hard cheese doesn’t contain very much lactose. You may also be able to retrain your digestive system to break down lactose by consuming smaller servings of milk several times a day for three or four weeks, according to Purdue University researchers. Some women also ﬁnd that drinking milk with meals minimises symptoms. “I recommend starting with half a cup of milk with a meal, and if this is tolerated, after a few days, slowly increasing the amount so you’re sipping 2–3 cups a day,” says the author of the study, Dennis Savaiano, Dean of Purdue University’s School of Consumer and Family Sciences in West Lafayette, Indiana. Or try drinking lactose-free milk and/or taking tablets that protect against lactose intolerant symptoms (see the sidebar Ban The Bloat on the next page). 4 5 ● you’re eating too much fruit. A University of Kansas Medical Center study found that almost half of all patients who complained of unexplained gas and bloating after taking 25 grams of fructose (the simple sugar found in fruit) were actually fructose-intolerant, meaning their bodies can’t digest fructose properly. Like lactose intolerance, this condition can be diagnosed with a breath test. If you’re fructose-intolerant, the ﬁrst thing to do is to steer clear of products that contain fructose as its primary sugar, such as apple juice, says author of the study, Peter Beyer, a professor of dietetics and nutrition at the University of Kansas. While you won’t need to totally swear off fruit, you may need to avoid certain types. “You should limit your consumption of fruits that are high in fructose, such as apples and bananas,” Beyer explains. One medium apple has about 8 grams of fructose, one medium banana almost 6, a cup of cubed cantaloupe has 3 and apricots have less than a gram apiece. Another strategy: Spread out your daily fruit servings so you don’t eat them all in one sitting. ● you’re chewing gum to keep from snacking. Believe it or not, chomping on gum is one of the main causes of stomach problems. “You often swallow lots of air, which can create gas and bloating,” explains Christine Frissora, a gastroenterologist at New York Presbyterian Hospital in New York City. In addition, some sugarless gums contain the sweetener sorbitol, small amounts of which can contribute to swelling in your belly. “Sorbitol pulls water into your large intestine which can cause bloating and even diarrhoea, in high doses,” Cox explains. A study in the journal Gastroenterology found that just 10 grams of sorbitol (the equivalent of a few sugar-free candies) was enough to produce symptoms, while 20 grams caused cramps and diarrhoea. Other sugar substitutes to monitor: maltitol, mannitol and xylitol, found in some sugar-free gum and low-carb products. (Sometimes listed as “sugar alcohols” on labels.) 7 ● you’re sensitive to wheat. In people with celiac disease – also known as gluten intolerance – gluten (found in wheat, rye, barley and many packaged products) sets off an autoimmune response that causes SHAPE August 2006 | live healthy | 55 their bodies to produce antibodies that attack the villi, those tiny hairlike projections in the small intestine that absorb vitamins, minerals and water, Cox explains. Over time, the villi is damaged, causing abdominal cramping and bloating, and prevents you from absorbing nutrients. This makes you more susceptible to vitamin and mineral deﬁciencies and conditions like anaemia and osteoporosis. The bad news: Celiac disease has a strong genetic link. It occurs in 5 to 15 per cent of the children and siblings of people who have it. Although the diagnosis can be made via a simple antibody blood test, Celiac disease is easy to miss as the symptoms closely mimic that of other conditions like lactose intolerance and IBS. “I’ve diagnosed women with this condition who’ve suffered for years and have been misdiagnosed or told by doctors that their symptoms were all in the head or stressrelated,” Frissora says. To manage the condition, eliminate grains such as wheat, rye and barley from your diet. “Following a gluten-free diet is incredibly tricky. You may have to visit the nutritionist to sort out what you can and can’t eat,” Early acknowledges. “But once you modify your diet, the symptoms will disappear.” Gluten-free products are available at natural-food markets and health food stores. 8 ● you’re overweight. Carrying extra weight can leave you more susceptible to developing gallstones, the solid deposits of cholesterol or calcium salts that can cause severe pain in your upper right abdomen, Raymond says. Women between the ages of 20 and 60 are three times more likely to develop them than men. Excess weight also increases your risk of GERD. A study published last August by the Baylor College of Medicine found that overweight people were 50 per cent more likely to have GERD than those of a healthy weight. “Extra weight puts pressure on your stomach, which in turn puts pressure on the valve between the stomach and the esophagus, making it easier for acid to back up,” Early explains. Losing 4.5 to 7 kilogrammes may be enough to eliminate the problem. 56 | live healthy | SHAPE August 2006 BAN THE BLOAT Is lactose intolerance leaving you sick to the stomach? If so, opt for these tummy friendly choices. By Camilla Chiam • Vitagen ($2.65 for a six-pack, at supermarkets) This cultured milk drink is lactose-free and contains less sugar than other probiotic drinks on the market. • Marigold HL Low Fat Milk ($2.50 per litre, at supermarkets) Suitable for lactose intolerance sufferers as the milk sugar is broken down and more easily digested. Low in lactose and high in calcium, protein and vitamins A, B1, B6, C and D3. • Wyeth Enercal Plus ($11.65/400g, $21.65/900g from pharmacies and leading supermarkets) A lactose-free, vanilla ﬂavoured shake packed with 26 nutrients like calcium, iron and zinc. It’s also low in cholesterol and sodium and contains no vegetable fat. • Dairy Care Digestive Supplement ($28.35 for 30 capsules, at Guardian, Unity and Watsons stores) Take these supplements which contain “active’’ lactobacillus acidophilus. Each dose gives you a day’s protection against lactose intolerant symptoms like nausea and cramping. • Marigold Fresh Soya Milk ($1.60 per litre, at supermarkets) Soya bean milk is ideal for those who are lactose intolerant. This contains ﬁve types of vitamin B and a Bone plus formula with vitamins K and D. It’s also cholesterolfree, preservative-free and low in saturated fat. Choose from four versions – Hi Calcium Fresh Soya Milk, Reduced Sugar Fresh Soya Milk, Sugar Almond Fresh Soya Milk and Reduced Sugar Wheatgrass. PRODUCT PHOTOGRAPHY DARREN CHANG STYLING JUDY WANG Stop chewing gum if you have stomach problems as it creates gas and bloating.