From Intolerance to Gluten
As a young firefighter and paramedic in St. Petersburg, Florida, Ryan Mitchell worked in a profession known for its high macho quotient and stoic heroism. But often, his body reacted like a baby who had just been fed a bowl of three-alarm chili. And he was embarrassed.
It began in the fall of 2002, when the 21-year-old would get stomachaches after eating certain foods. By December, he couldn't keep anything down, and he was plagued by horrible, ripping cramps and diarrhea. "I was running to the bathroom six or seven times a day," Mitchell recalls. When responding to car accidents, fires and other emergencies, he'd get the unmistakable urge and sweat it out until he could get to a toilet. "As soon as a call was over, I'd have to beg the engine driver to pull over at a gas station, or I'd even use the bathroom at the scene. I'm not sure how I did it. The pain was practically unbearable."Mitchell's stomach troubles and frequent bathroom breaks also got in the way when it came to dating, running errands -- just about everything. "I had to plot even the most mundane things," he says. "And I knew where every gas station in the county was."
He thought he had caught some kind of infection, but his doctor told him it was simply stress-related and offered him Valium. Mitchell, a laid-back guy, was pretty sure this wasn't the problem and didn't want to take the drugs. When the six-foot-four, 180-pound fireman's weight plummeted to 156, he finally went to a gastroenterologist. Right away, the doctor suspected celiac disease, a condition marked by an intolerance to gluten. A blood test and a biopsy of the small intestine confirmed the diagnosis. The treatment? Eliminating all gluten-containing foods, such as wheat, barley and rye, from the diet. Within a few weeks, Mitchell noticed improvements, but it took more than two years for all his symptoms to disappear.
Gastrointestinal disorders plague more than 60 million Americans. Some are more serious than others. But all can be painful, puzzling, embarrassing and tricky to diagnose and treat. So how do you know if your stomachache is the result of a pathogen, an overindulgence, stress, an allergy or some rare disorder?
Everybody Hurts
"Stomach pain is part of life," says Douglas Drossman, MD, codirector of the University of North Carolina's Center for Functional GI & Motility Disorders. "If we look at a million people, probably 800,000 of them will have stomach pain in a year. Maybe 100,000 have irritable bowel, and 100 have the more serious inflammatory bowel disease."Often a stomachache is just a stomachache. But if you've had pain for six months, or experience serious symptoms such as blood in the stool or unexplained weight loss, see a doctor. There are more than 100 possible causes for your pain. Here, how to recognize a few of the most common:
Irritable bowel syndrome. IBS is one of the toughest disorders to diagnose and treat. Your belly aches, you're bloated, and you have constipation or diarrhea (or both), but tests show there's nothing wrong. Is it all in your head? No. It's in your gut, and it's not going away quietly. "Sometimes tests rule out other possibilities, but increasingly we make the diagnosis based on the patient's description of symptoms," says Colin Howden, MD, professor of medicine in the GI division at Northwestern University. Sometimes IBS begins after an infectious disease like traveler's diarrhea.
Once you've been diagnosed, your doctor may suggest dietary changes, such as eating more fiber or taking supplements (increase fiber gradually, since an excess can cause bloating, gas and diarrhea). Keeping a food diary to figure out what triggers symptoms, and then avoiding those foods, helps some people. Doctors may also prescribe antibiotics (to reduce bacteria in the intestinal tract) or probiotics (to shore up healthy bacteria). Zelnorm, a drug that offered relief to many, was pulled off shelves by its manufacturer earlier this year after it was found to increase the likelihood of heart attack and stroke in people with a history of heart disease or those at risk for the condition. But in July, the FDA said women under 55 with chronic constipation or IBS and no history of heart disease can still get the drug. And there are other medications on the horizon that seem to work in a similar way. Some doctors are prescribing the constipation drug Amitiza as a replacement.
Celiac disease. Widely underrecognized in this country but starting to gain notoriety, celiac disease is a sensitivity or allergy to gluten, a family of proteins found mostly in grains, including wheat, barley and rye. Some sufferers also have trouble with oats. It may cause stomach pain, diarrhea, bloating, weight loss, anemia and just a vague not-so-good feeling.
The healthy small intestine is lined with villi, fingerlike projections that absorb nutrients and fluids, says Amy Foxx-Orenstein, DO, president of the American College of Gastroenterology. In celiac disease, the villi get lost or damaged, so your body doesn't absorb much of anything. It all goes rushing through your system, with the aforementioned unpleasant results. When you eliminate gluten from your diet, the villi return and your symptoms go away over time.
Unfortunately, gluten is everywhere: cereal, pasta, bread, cookies and processed foods. Avoiding it can be tough, but more and more gluten-free products are popping up, and there are plenty of cookbooks for the gluten intolerant. If you think you have celiac, see your doctor before you cut out these foods. The tests that clinch the diagnosis can come back negative if you've stopped eating gluten.
Crohn's disease. It's a form of inflammatory bowel disease, a group of conditions in which the GI tract is chronically inflamed. Crohn's symptoms are similar to those of IBS, but unlike IBS, in which there's no detectable damage to the digestive system, Crohn's causes the intestine to be inflamed. This can narrow the end of the small intestine, says Dr. Howden, so it has to work harder to push waste through, causing stomach pain (especially while eating), diarrhea, vomiting and weight loss (you tend not to eat much when it hurts to do so).
What causes Crohn's? Genes may play a role, or the origin may be environmental (something in your diet, a bug). It's diagnosed in many ways: Your doctor may feel a mass in your abdominal cavity, you may have abnormal blood tests, or other tests may reveal nutrient deficiencies or ulcers. Endoscopy, X-rays or an intestinal biopsy can confirm the diagnosis. In the past, the condition was often treated with steroids, but today many doctors prescribe immunosuppressant drugs or IV infusions, which have fewer side effects. Eating more protein and avoiding foods that take a long time to break down (including many fruits and vegetables) can help prevent the pain.
Stress Connection
You fly past a cop while you"re going 20 miles over the speed limit, or you"re about to give a speech or go on a job interview. All of a sudden, you feel cramping stomach pain, the need to rush to the bathroom. What gives? Blame the enteric nervous system (ENS). It"s your gut"s "brain," and it has its own muscles, nerves and neurotransmitters, which tell the gut to move its contents through the body. The ENS is always communicating with your brain, sending signals back and forth. But when you"re stressed, there are an abnormal number of signals firing away. That can lead to discomfort, says Dr. Foxx-Orenstein.The vagus nerve, which runs from the brain to the intestines, is also at play here, says Mehmet C. Oz, MD, director of the Cardiovascular Institute at Columbia University Medical Center in New York City and coauthor of the You health books. "There"s a very close connection between your brain and your gut, so it"s not surprising to think that if your brain is overstressed, the same thing is happening to your gut," he says. Reducing stress, through meditation, exercise, deep breathing, yoga, or whatever works for you, may help ease your symptoms.
Something You Ate?
Each year, some 76 million people spend time hugging the porcelain throne thanks to food poisoning. But how can you tell if last night"s dinner is to blame for your distress? Gastrointestinal disorders tend to start slowly and gradually worsen, but food poisoning hits from 4 to 24 hours after eating, and comes with a bunch of symptoms: nausea, vomiting, fever, stomach pain, diarrhea, says Dr. Foxx-Orenstein. "If you can"t keep fluids down and you have watery diarrhea for more than 12 to 24 hours, or the discomfort is too much, see a doctor or go to the ER," says Dr. Oz. You"ll get pain relief and hydration.
Doc, Can We Talk?
"We assume that everybody is embarrassed to talk about their bowels, even doctors, even specialists," says Jack A. DiPalma, MD, director of the division of gastroenterology at the University of South Alabama. "But we"re used to hearing about embarrassing symptoms that people usually don"t want to talk about, and there"s very little doctors haven"t heard. A good doctor will be sensitive about that." Before your appointment, make a list of tests you"ve had, doctors you"ve seen about the problem, hospitals you"ve been to, conditions you"ve been told you have, other therapies and medications you"ve tried (that includes prescription and over-the-counter drugs, and yes, alternative therapies). How have your bathroom habits changed? Think seriously about your symptoms, says Dr. DiPalma. What provokes them (stress, fatty foods)? What eases them (antacids, stress reduction)? What does it feel like (burning, aching)? Where, when and how badly does it hurt??
Got Gas?
The average person passes gas between 14 and 23 times a day. When you"re struck with painful bloating and gas, try taking an antacid or Pepto-Bismol to coat your stomach, or probiotics to ease your symptoms. Over-the-counter products that reduce gas may contain simethicone or activated charcoal, but they"re not that effective, say experts. Generally you just have to wait it out (or let it out!). "There are no easy ways of getting around gas, only easy ways of avoiding it in the future," says Mehmet Oz, MD. If you suspect that bulking up on veggies or beans is the problem, try Beano before your next meal. The supplement contains an intestinal enzyme that helps your body break down complex carbs. How to avoid the problem: