Image: Woman with hand on man's belly
Patrick Sheandell O'Carroll  /  Getty Images stock
Even if you have ripped abs, digestive problems can turn and knot anyone's stomach.
updated 3/19/2009 8:25:45 AM ET 2009-03-19T12:25:45

Mark Smith is a 27-year-old lawyer living in Washington, D.C. Only that's not his real name. Like any smart lawyer, he doesn't want clients Googling him and reading up on his stomach woes, which include diarrhea, gas, and knife-sharp pains. "I won't schedule meetings before 10 a.m.," he gripes. "My stomach goes nuts after breakfast."

The shame and discomfort pass, along with his stool ... eventually. And Smith isn't alone: Digestive problems can turn and knot anyone's stomach. Like your skin, the lining of your stomach comes into direct contact with the big, bad outside world 24/7. When this protective layer fails to absorb the helpful stuff or block the harmful stuff, your entire body is imperiled. So we talked to the best gut docs to learn what you should and shouldn't be doing to pacify the growling beast in your belly. Start by answering the following questions.

Are you taking in enough fiber? Are you eating the right kind?
Why it's important: Fiber adds bulk to stool, speeding its transit through your intestine so your body has less time to absorb toxins. "Fiber is also used as food for many of the healthy microbes lining the colon," says Walter J. Coyle, M.D., gastroenterology program director at Scripps Clinic Torrey Pines, in La Jolla, California.

How to make the grade: Aim for 25 to 30 grams of fiber a day, including seven to nine servings (½ cup each) of fruits and vegetables. "Their fiber has phytochemicals and antioxidants that benefit your colon lining," says Dr. Coyle. Need help topping off your tank? A methylcellulose-based fiber supplement, such as Citrucel, won't cause flatulence.

Gut goof-up: Don't go from 3 grams to 30 overnight, or you'll pay an embarrassing price. "That will lead to bloating and flatulence," says Dr. Coyle. "Start slowly, and gradually increase your intake from there."

Are you taking prebiotics along with your probiotics?
Why it's important: You've probably heard about probiotics, those friendly microorganisms that help regulate digestion. But to get the most out of them, you need prebiotics, carbohydrate fibers (a.k.a. oligosaccharides) that your stomach and small intestine can't digest. Once these fibers reach your large intestine, bacteria break them down, feeding the good microbes.

"Prebiotics increase the number of beneficial bacteria in the intestine and help maintain the populations of friendly bacteria already present there," says James Versalovic, M.D., Ph.D., the director of microbiology at Texas Children's Hospital and an associate professor of pathology at Baylor College of Medicine.

How to make the grade: Along with taking a daily dose of a billion units of probiotics, consume 5 grams of prebiotics. Quality yogurts and other fortified dairy products provide plenty of the former; artichokes, wheat-based cereals, onions, garlic, and bananas are particularly rich sources of the latter. Prebiotic-fortified foods are also available — look for the words inulin and fructooligosaccharides on a product's list of ingredients. Or mix a 3-gram scoop of Jarrow Formula's Inulin FOS with juice or water and drink it twice a day.

Gut goof-up: If you miss a dose of prebiotics, there's no need to push the panic button. "Nutrients stay in the gut for quite a while," says Dr. Versalovic.

Are you using antibiotics only when you need them?
Why it's important: Antibiotics seek to wipe out unwanted infectious agents, but there's collateral damage. "An antibiotic is like an atomic bomb exploding in the colon," says Patricia Raymond, M.D., a fellow of the American College of Gastroenterology. "Healthy microbes die indiscriminately."

Suddenly, Clostridium difficile — hardier, harmful bacteria the good guys would normally keep in check — multiply faster than short sellers torpedoing an investment bank's stock.

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Do you find yourself sprinting, not strolling, to the john? "Bloating and diarrhea after taking an antibiotic are a sure sign you've disturbed your gut flora," says Dr. Coyle. Losing those helpful native bacteria also weakens your immune system.

How to make the grade: "Don't think every sniffle or sneeze begs for an antibiotic," says Dr. Raymond, who notes that antibiotics are powerless against colds and the flu anyway. "If you need an antibiotic, take one that attacks the specific bacterial infection you have. A broad-spectrum drug like Cipro pretty much wipes out all existing life forms in the vicinity."

Gut goof-up: Taking a probiotic while you're taking an antibiotic (and then for 4 to 6 weeks afterward) can help lessen the side effects; however, good bacteria like acidophilus will be crushed. A nonprescription yeast probiotic, such as Florastor, will be unaffected by an antibiotic.

Are you steering clear of antacids when heartburn hits?
Why it's important: Let's say reflux — that horrible half-belch, half-barf thing where the contents of your stomach flow back up your esophagus — won't leave you alone. Chances are you'll reach for Mylanta, Prilosec, or another acid-suppressing drug.

The problem is, acid may not be why you're refluxing; if it happens more than twice a week, it could be gastroesophageal reflux disease. The problem lies with the valve separating your esophagus from your stomach. What's more, neutralizing that acid can harm your gut. Stomach acid is there for a reason: to handle live bacteria in our diet.

How to make the grade: Ditch the conventional antacids and take a liquid version called Gaviscon instead, says Dr. Raymond. "It contains a compound called 'alginate' that doesn't try to neutralize all of the acid," she says. "It floats on top of the acid, creating a foamy barrier that prevents burning sensations."

Gut goof-up: Sleeping off a big meal. The longer that late-night Italian sits in your stomach, the likelier it will attempt a comeback. Going for a 30-minute walk will help usher food into the intestine.

Do you avoid popping pain pills unless you really need them?
Why it's important: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are kryptonite for your gut. Using them for acute pain, like a major headache, is fine once in a while. But popping Advil like M&M's can lead to stomach ulcers by decreasing prostaglandins that produce the mucus that normally seals your stomach. Acid can then escape and wreak havoc.

Aside from the pain and bleeding they cause, ulcers can deform and scar your stomach, much as a weekend duffer's golf swing kicks up wads of grass. A perforation, for example, is a hole that can extend all the way through your stomach lining to your abdomen — which is not the place you want lunch emptying. Perforations can be quite serious, usually requiring surgical repair.

How to make the grade: Switch to Tylenol, since acetaminophen won't damage your stomach lining the way NSAIDs do. Deglycyrrhizinated licorice (DGL), an herbal supplement, has been used to help heal the stomach's mucous membrane, safeguarding it from stomach acid. So chew 350 milligrams of DGL along with that ibuprofen if you're an occasional pill popper, or take it before meals and bedtime if you're a chronic user. Just make sure not to grab licorice or licorice root instead. Both contain glycyrrhizic acid, the blood-pressure-boosting compound that's been removed from DGL.

Gut goof-up: Taking NSAIDs on an empty stomach. "Food can buffer their negative effects on the gut, in part by keeping them from being absorbed too quickly," says Dr. Raymond. "Taking NSAIDS on an empty stomach can cause a really deep ulcer to form."

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