Digestive System Conditions From Top to Bottom

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Milk Thistle

Native to Europe, milk thistle (Silybum marianum) has long been used as food and medicine.11 Currently, it's used to treat alcoholic hepatitis, liver cirrhosis, liver poisoning, and viral hepatitis and to protect the liver from the damaging effects of toxins.11

Cristina Caro, MBA, RD, LD, a consultant dietitian and adjunct faculty member at Chattahoochee Technical College in Atlanta, recommends milk thistle to clients who experience sluggish digestion and metabolism and to keep liver cells healthy. She suggests patients take a 175- to 200-mg capsule of milk thistle per day for 60 days (standardized to contain 70% to 80% silymarin) to support the regeneration of liver cells. However, it's important to know that while milk thistle has been shown to protect the liver from toxins in animal studies, human studies haven't demonstrated this, according to NYU Langone Medical Center.11

In general, milk thistle is well tolerated, although GI side effects have been noted as well as its tendency to lower blood sugar, so caution should be used for anyone at risk of hypoglycemia.12

Slippery Elm
As the name suggests, slippery elm (Ulmus rubra) contains a gel-like substance called mucilage that coats the esophagus. It's this substance that may make slippery elm an effective natural treatment for GERD. The herb is available as a lozenge, capsule, tincture, or tea to treat digestive distress.

According to the University of Maryland Medical Center, the doses health care practitioners may recommend to clients will vary based on the preparation. Typical doses may include 4 g of powdered bark dissolved in 2 cups of hot water three times per day or 400 to 500 mg in capsule form three to four times per day for four to eight weeks.13

Although slippery elm appears to have no serious side effects, its coating effect may reduce the absorption of certain medications, so it's important to tell clients to take it separately from medications they may take for other illnesses. As with all herbal remedies, pregnant or breast-feeding women should discuss the use of slippery elm with their health care provider. The efficacy of slippery elm is widely reported, though no clinical trials have been found to support its use.

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Pineapple Extract

"As a teen, I worked in a health food store and learned about eating pineapple to manage an upset stomach, and it's worked for me since then," says Cindy Culver, MS, RD, LD, a school nutrition professional in Smyrna, Georgia.

Culver found eating pineapple (Ananas comosus) helpful because it contains digestive enzymes that have been touted as a treatment for heartburn and indigestion. Many alternative and complementary medicine specialists promote bromelain (extracted from pineapple), one of the digestive enzymes, as a treatment for various conditions, and there's some support that it may be effective as an anti-inflammatory to treat arthritis and muscle soreness. However, little evidence exists to support its use for digestive disorders.14

Large doses of bromelain may cause stomach upset, and it's recommended that individuals stop using it at least two weeks before surgery because it may increase the risk of bleeding.

Probiotics

Probiotics are heavily marketed as a way to help regulate digestion. They're a well-known treatment for antibiotic-induced diarrhea, and the use of probiotics containing bacterial strains such as Saccharomyces boulardii and Lactobacillus rhamnosus GG are supported in the literature.15

It's important to recognize that of the many different probiotics products available, not all bacterial strains they contain have been studied for efficacy. Clients must choose the right type of probiotic for them and concern themselves with whether the bacteria they ingest can withstand stomach acid and make it into the intestines alive to be of any benefit.

Tracy Smith, RD, LD, a bariatric dietetics specialist, recommends probiotics to treat both diarrhea and constipation to her clients. However, a recent meta-analysis considers their use for constipation investigational and not yet supported by research.16

Rather than supplements, Connie Crawley, MS, RD, a University of Georgia Cooperative Extension nutrition and health specialist, recommends kefir milk to treat GERD. "I use it because of the probiotics. It has 10 [strains of bacteria] vs. the normal two in yogurt," she says. She suggests clients drink at least a 1/2 cup per day but says a 1/2 cup per meal is even better. To increase its palatability, she recommends mixing half of the kefir milk with nonfat milk or choosing a flavored variety.

Food First
Dietitians know that altering the diet using medical nutrition therapy and eating specific foods can help treat the symptoms of transient digestive discomfort and chronic disease. The following are a couple of additional foods dietitians can recommend to clients to treat common digestive disorders:

• Milk: Drinking a glass of milk has long been recognized as a home remedy to treat heartburn. In fact, Rogers recommends it and reports success with her clients who suffer from GERD. It's believed that milk may serve as a temporary buffer for stomach acid. The fat in milk may cause additional discomfort, but clients can avoid this by drinking fat-free or low-fat varieties. Anecdotal reports support the use of milk to treat GERD but not much clinical evidence exists.

• Honey: In a 2002 BMJ letter, Indian researchers reported success using honey to treat heartburn, noting it's commonly used in Ayurvedic medicine.17 It's believed that the viscosity of honey coats the upper gastroesophageal tract, preventing the stomach acid from rising. There appears to be no significant support for this in the literature, yet the combination of milk and honey to treat heartburn remains popular.


No Silver Bullet
Many natural remedies for digestive disorders are relatively harmless, and some may provide simple, inexpensive treatment for transient conditions, but they're no magic cure for the more serious digestive disorders. It's important for dietitians to make recommendations with the research (or lack of research) in mind and inform clients of the evidence for or against such remedies.

In addition, RDs should rule out more severe disease by taking an interdisciplinary health care team approach to helping clients with chronic digestive discomfort.

Regardless of an individual's digestive disorder, modifying his or her diet by eliminating offending foods and reducing overeating is key. Lifestyle changes such as increasing physical activity and stopping smoking also are essential since obesity, smoking, and stress are known to increase GI distress.

Helping a client develop a nutrient-rich diet and overall healthful lifestyle are important tasks for the dietitian, despite other therapies the patient may be using. According to Patsy Catsos, MS, RDN, LD, a consultant dietitian at Nutrition Works and the author of IBS — Free at Last! "A whole foods diet that's well matched to the patient's needs is the best natural remedy."

— Sherry Coleman Collins, MS, RDN, LD, is an Atlanta-based nutrition consultant, writer, and dietitian in private practice, specializing in food allergies and digestive disorders.

 

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Crohn's disease (a type of inflammatory bowel disease)

Crohn's disease is a chronic (long-term) inflammatory disease that primarily affects the small and large intestines. The disease results in the inflammation of the digestive tract, which can cause:

Diarrhoea
Abdominal pain
Blood in stool
Malnutrition
Weight loss
Fatigue
The inflammation can involve different areas of the digestive tract, and often spreads deep into the layers of affected bowel tissues. Crohn's disease can be painful and debilitating, and may lead to serious complications.

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Irritable bowel syndrome (IBS)
Irritable bowel syndrome (IBS) is a common condition affecting how the digestive tract senses or responds to food, drinks or gas. It can cause:

Gas and bloating
Pain and discomfort
Changes in bowel habits (constipation or diarrhoea)
Learn more about IBS and its treatment options.

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Colon polyps
Polyps are abnormal growths. In the lower GI tract, they usually form on the lining of the colon (large intestine). Whilst most polyps are non-cancerous, certain types may eventually develop into cancer.

Most polyps do not cause any symptoms unless they grow to a certain size, which is why regular screening is important. Colon polyps can cause:

Abdominal pain
Blood in the stools, which may indicate bleeding in the colon.
Changes in bowel habits such as constipation or diarrhoea that lasts longer than a week.
Fatigue, shortness of breath, or anaemia, which are indications of chronic bleeding.

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