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Why Do I Feel Poorly After Eating?

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on 4 January 2014

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Transcript of Why Do I Feel Poorly After Eating?

Stress
Immune System
Drugs
Bugs
Why Do I Feel Poorly After Eating?
This challenging question has been the focus of my practice for many years.
My patients report their frustration after seeing multiple physicians, taking a wide variety of tests, and trying numerous treatments. In fact, people tell me of great frustration with doctors looking for cancer and colitis, but not addressing how the patient feels. I won't try to over simplify the problem as the causes vary but there are many things to learn.
Food
When people ask me why I went into gastroenterology, I tell them it's all about the food!
The understanding of the relation of symptoms to food led to development of the Specific Carbohydrate diet and the low FODMAP diet. There are other food triggers such as lactose, fructose, galactans, polyols, and fructans, for example. If you have abdominal distress, perhaps with bowel changes or gas, you should avoid sugar substitutes and sugar–free products, as well as soda. You may need a test for lactose intolerance.
An explosion of awareness of the gluten free diet led to improved labeling and increased gluten free food choices becoming available. In addition to people with Celiac disease, many other people found that going on a gluten free diet gave them relief of a variety of symptoms. They found that gluten free diet improved their gastrointestinal symptoms greatly without the need for medication. They report less bloating, diarrhea, constipation, gas, and headaches. In fact it has helped many with autism have better behavior control. The diet is also used for frequent migraine sufferers.
WARNING: DO NOT BEGIN A GLUTEN FREE DIET
Have a blood test for Celiac Disease before trying a Gluten Free Diet for any reason. Without the blood test it becomes impossible to tell if you have Celiac Disease or non-celiac wheat sensitivity. Both improve with diet. This has important long-term consequences. The test cannot be relied upon after you have been on the gluten free diet consistently.
The brain bone is connected to the gut bone.
The gastrointestinal tract is clearly linked to emotion. We talk about stress leading to ulcer pain, first love as butterflies in the stomach, anxiety leading to diarrhea or distress leading to loss of appetite. So, is the gastrointestinal tract all in your head? Actually, it is not, but there is a great deal of overlap here that is exciting to review.
The relationship starts with the gastrointestinal hormones found both in the brain and gut. You may know that Serotonin is key to anxiety, motivation and mood. Did you know that 95% of the Serotonin receptors are in your gastrointestinal tract controlling the flow through your intestines (motility), secretion of fluid, and abdominal pain? Many more gut hormones are important in the feeling of satiety and hunger. These relationships between the brain and the gut hormones and nerves are referred to as the brain-gut axis.
Brain-Gut Axis
Pain is not a one-way street.
When you cut your finger a pain signal passes from your hand to the spinal cord and to the cortex of the brain. That is not all. At the same time as these signals are going to the brain there is a filtering process going from the brain and spine that alters that pain signal. These filters may reduce or amplify the pain that you feel. For example, the marathon runner is injured and continues the race impervious to the pain of the injury. Once the race is done, the pain is unmasked and then he collapses. The transmission of pain and other symptoms from the gut is either filtered or enhanced because of these two direction processing from gut to brain AND brain to gut.
Helicobacter pylori
In 1982 a revolution was born when Nobel Prize winning research demonstrated that an infection caused ulcers. Helicobacter pylori, one of the most common infections in the world causes ulcers in the stomach and duodenum, as well as gastritis (an inflammation of the stomach lining unrelated to "gas"), stomach cancer and lymphoma of the gastrointestinal tract. H. pylori is treated with antibiotics but is difficult to get rid of. It is most often acquired in the home as a child or teenager. So if your father had an ulcer, you won't inherit it but you likely caught it.
SIBO
20 years later another pioneer demonstrated that Irritable Bowel Syndrome can be treated with antibiotics very successfully. They termed the condition Small Intestinal Bacterial Overgrowth. The term is faulty and should be replaced with dysbiosis. This is not an infection, but rather an alteration in the balance of bacteria in the gut. It often alters bowel function and leads to the distension many patients describe as feeling pregnant.
Irritable Bowel Syndrome
One of ten people who suffer from an intestinal infection, for example salmonella, will not recover normally. They will continue to complain of abdominal cramps or pain, constipation or diarrhea, bloating, bowel frequency or incomplete bowel movements. When these symptoms persist over 6 months we can diagnose post-infectious Irritable Bowel Syndrome. We have already spoken of Irritable Bowel Syndrome being related to the foods we eat, the stress we face, but now add to that the bacteria in our intestines!
Conclusion
Abdominal distress is generally caused by these five elements: Food, Stress, Bacteria, the Immune System, and Medications. These form the basis of my diagnostic and treatment plans for nearly every visit.

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We're Number 2
The gastrointestinal tract is the second most active immune organ in the body. The skin is our primary line of defense, but after that our mouth and gut are the major portals of entry into our bodies. There are antibodies and lymph tissue throughout the gut serving a major defense from disease. So it should not come as a surprise that when these barriers go awry, there is the risk of disease.
Auto-Immune Disease
There are disorders where the gastrointestinal tract attacks itself as if it were a foreign invader. This is known as autoimmune disease. Examples include Ulcerative Colitis and Crohn’s Disease. These are treated with medications that reduce inflammation by turning off components of the immune response. The risk is that you need those responses to fight infection and prevent cancer. By being very selective, we can minimize these risks.
Vitamin D
I will highlight two crucial issues that affect the onset of autoimmune disorders. Most of us are very deficient in Vitamin D. The levels we need to prevent thinning of the bones are not adequate to protect from autoimmune disorders and cancers such as colon cancer. Low Vitamin D levels have also been associated with development of Ulcerative Colitis.
Immune Tolerance
In early childhood, we develop immune tolerance to our environment so that we don't treat everything as foreign. Children raised on a farm in early life have far less risk of developing Ulcerative Colitis than children of the suburbs. The children exposed to the farm environment at a young age adapt better.
Both food allergies and food intolerances are real and on the rise.
Immune Tolerance is on the decline as evidenced by the epidemic of food allergies. Children may not bring cupcakes for the class on their birthday because Johnny is allergic to peanuts, Suzy can't have eggs and Joey can't have wheat. This truly is a rapidly growing problem. Celiac disease is on the rise. So are Eosinophilic Esophagitis and other allergic disorders. In Eosinophilic Esophagitis, the food allergies lead to blockage of the esophagus causing difficulty swallowing food.
For example, a patient may come to me on a Proton Pump Inhibitor, a potent treatment for ulcers and acid reflux. It was prescribed initially for acid symptoms. Those symptoms have improved and the treatment was successful. The acid blocker was never stopped despite resolution of the initial problem. The patient is now complaining of gas and bloat and changes in the bowel movements. These are common side effects of these very useful medications. The key is that all medications should be periodically reviewed for continued necessity and adverse effects.
Medications are very valuable tools and should never be stopped without advisement of your physician. It is key to periodically review long-term medications and ask the questions
•Is this medication still helping my condition?
•Are any of my current symptoms being aggravated by my medication?
Always bring a full list of medications, herbals and vitamins to every physician visit. Always ask your physician to check for drug interactions (a feature found on every doctors computer nowadays) and to keep your list up to date.

Many gastrointestinal symptoms are caused by medications. For example, intestinal spasm medications may cause dry mouth, constipation, acid reflux or dizziness. Treatment given for bladder symptoms may lead to constipation and dry mouth. Niacin, a natural vitamin used for cholesterol may cause chest pain and heartburn.
So much of medical intervention is drug based. People are on more medications than ever before. Each pharmaceuticals and nutritional supplement has to be judged on its merits. Far too many patients don't know why a medication was recommended. The initial condition may have resolved while the patient is still on the same treatment. Doctors often will not review a treatment initiated by a physician or hospital no longer involved in the patients care.
A Gastrointestinal Health Presentation by Dr. David Gutman, MD, FACG
RefluxNY.com
We will discuss the five key areas that affect your gastrointestinal health in this seminar.

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For a long time, food was not truly part of the GI training and literature. Now, finally, the science is catching up with what I knew all along. For example, Celiac Disease is an autoimmune disorder where people are allergic to to gluten found in wheat, rye, and barley. Around 2000 we started realizing that Celiac disease was much more common than we had imagined. Originally we thought it affected one person in 4000. Now we realize that one person in 150 has this allergy. We had been greatly overlooking this important disorder.
Our experience alter our perceptions
The person with a history of abuse feels more pain and more nausea in response to a mild stretching of the intestine that another person does not feel at all. One person has activation of the limbic system that enhances the symptom of pain and recruits other symptoms such as nausea. Another person has activation of the anterior cingulate cortex that alleviates the sensation and makes it very tolerable. People with Irritable Bowel Syndrome often have histories of emotional stress or history of abuse more often than people without these symptoms. Amplification of noxious stimuli is called Visceral Hypersensitivity.
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