Dr Prasanna Shah, leading consultant gastroenterologist addressed questions on Acidity, Gas and Heartburn as part of the Health Live @ Seniors Today series. Dr Noor Gill captures the highlights
On Saturday, leading consultant gastroenterologist Dr Prasanna Shah addressed questions on Acidity, Gas and Heartburn as part of the Health Live @ Seniors Today series. Dr Shah is attached to the Breach Candy, Jaslok and Saifee Hospitals in Mumbai. He has vast experience in therapeutic endoscopy and now metabolic correction endoscopy for weight loss.
Before he started answering questions on the topics for the day, Dr Shah was asked a few questions on the ongoing Covid-19 pandemic. Are we in a good phase or are we in a bad one? Are we turning the corner? Dr Shah thinks we are somewhere in between and we are doing well. We are expecting some good news, hopefully around the corner. And a good marker for that is the hospitalization numbers, which because of the Covid pandemic had definitely come down, but now 80% of the hospital beds have finally opened up for other non-Covid patients and that is a good sign of recovery.
Keeping in mind the current scenario, yes, one can go out but you have to adhere to the norms which are-
- Social distancing
- Wearing a mask
- Constantly sanitizing your hands
- Avoid touching your face, nose, eyes too frequently.
- Avoid crowded places. In populous cities like Mumbai, it is very hard to avoid crowded places. So only go out if it is absolutely essential. Otherwise stay put at your homes.
- And if you’re over 60 years of age, your hiatus at the house will continue. Please don’t go out. Stay safe, stay indoors.
And when should we expect the vaccine? We’re all awaiting the vaccine which should come out anytime between January and March 2021. By the time the schedules for vaccination delivery are put into place, the vaccines are delivered to everyone across, and the vaccinations are taken, we should be well in October 2021 or nearing the end of 2021. But it is important to remember, that the severity of the problem has come down and we are slowly but steadily turning the corner. There is no need to panic. All we need to do now is wait for the vaccine.
Moving on to the mainstay of the session:
Acidity is basically acid which is produced in the stomach, sometimes gets too much and can then cause symptoms. This then leads to inflammation in the lining of the stomach. The causes for acidity are many. Food allergies is one of the many very common but neglected causes for acidity.
it is an involuntary reflex where one emits air from the stomach, from where it goes beyond our cricopharynx which is our voice box, from there it goes in between the vocal cords, thus reverberating the voice box and producing a sound. Belching can be of two types:
- Passive belching
- Forceful belching
Nausea, vomiting and bloating- which are again symptoms of formation of gas in the stomach.
When it comes to acidity, bloating, it is usually has mostly to do with the lifestyle. One has to very strict and change their lifestyle, for the better, which includes
- Avoiding acidic foods
- Including 45 minutes of exercise in your daily routine.
- Avoid crunches and planks- exercises which increase the intra-abdominal pressure.
- Pranayama and shavasana are two good postures for people with acidity or reflux. These two asanaas calm the brain down and by extension the gut, this is called the brain-gut axis and these asanaas have a relaxing and calming effect on the axis.
- Your diet needs to be carefully curated and balanced.
- Instead of gulping your water sip it with a straw.
- Eat small portions of food and eat frequently. Do not eat large, voluminous foods.
- Do not eat late night meals or snacks.
- Try keeping a minimum of 3 hours of gap between your last meal consumed and your bedtime.
- Eating cold foods such as ice cream/kulfi, post meal can also act as a substitute to your antacid.
- Avoid stressful situations/ try to live a stress-free life as much as possible.
Avoid refluxer foods or foods which increase acidity, which include: Onions, garlic, mint, coffee, cheese, chocolates, etc.
Food items that increase stomach alkalinity include: Broccoli, green peas, spinach, coriander, oils such as coconut and avocado oil, grains, tomatoes, avocado, coconut, tofu, gluten-free breads, sprouts, nuts and seeds.
Side or adverse effects of consuming antacids for long durations – Loose motions, diarrhea, pneumonia, C. diff infections. These adverse effects, however, have been documented but are not very common.
Bicarbonates, such as Eno are good for temporary relief, but if you plan on using it for chronic problems, it can lead to an exaggeration of the reflux and acidity in the long run.
So, if you have gastric symptoms and are not responding well to the Proton Pump Inhibitors (PPIs) which act mainly by reducing the acid production by inhibiting the proton pumps, which are the first course of treatment to manage these complaints, then you need to undergo further investigation to find out the cause for it.
H. pylori can be one of the causes. H. pylori (Helicobactor pylori) is a type of bacteria which can enter your body through contaminated food and water and can reside in your digestive tract, causing gastrointestinal problems and symptoms such as gastritis, gastric ulcers and duodenal ulcers. In the long run, it can also cause cancer. WHO has classed H.pylori as a class-I carcinogen.
The number of people complaining of gas and acidity has increased over the years. And it has all got to do with our lifestyle. Our lives are jailed in our mobile phones and we’ve become couch potatoes. We really need to have some “me time” and we really need to get away from all of this. So, get out of your homes, exercise, watch what you’re eating. As they say “a slip on the lip, a lifetime on the hip”. Therefore, lifestyle changes and dietary modifications are important.
If you’re losing weight and there seems to be no apparent cause for it, you need to be investigated thoroughly, including your thyroid profile and looked at. Because if you’re losing weight, it means that there is an underlying problem either with the absorption or the digestion of the food that you are ingesting. It could also be mal-digestion or malabsorption. Some common cause for weight loss without any significant lifestyles changes apart from the GI causes could point at
- Thyroid disorders
- Diet lacking in protein rich foods
GERD or Gasrto-Esophageal Reflux Disease
It a very common gastric disorder, in which the acid in the stomach or the bile comes out in the food pipe and irritates the lining of the oesophagus. One of the most common extra-intestinal manifestations of GERD include blockage of the nasal passages post meals. The acid come up, hits the throat and causes sinusitis. And this phenomenon is called a Laryngopharyngeal reflux (LPR). It is a severe form of GERD.
Some patients also present with a sore throat, which is a result of the reflux, but instead of thinking of it as a gastric symptom, they treat it like a throat infection and treat it with antibiotics and get worse.
Some asthmatic patients of GERD also present with wheezing in the lungs, because minute amounts of the acid reflux goes into the lungs and causes bronchospasm. In such patients, if you clear them of their reflux, the asthma also gets resolved.
Irritable Bowel Syndrome
It is a group of symptoms clubbed together, including pain in the stomach, changes in the bowel movements, etc. And the first modality for treatment is dietary changes. Which included reducing the fiber content in the diet and increasing the fluid and water intake.
Certain foods that can sometimes cause bloating, pain in the stomach and indigestion include:
- Rice or other foods which are rich in carbohydrates
- Food items containing high contents of lactulose
- Potatoes and starch rich foods
This is a condition in which a part of your stomach pushes up into the chest cavity through the diaphragmatic muscle.
A small hiatus hernia requires lifestyle modification which may include, avoid putting on weight, exercising regularly and regular medications should help you keep it under control.
It is a condition which by virtue of affecting the stomach muscles also affects the process of stomach emptying.