Podcast: How Can I Avoid Holiday Bloat?

Episode Transcript

Dr. Kuo: So one of the key things is if you’re eating and indulging, and you suffer from these sorts of issues, please don’t go to bed, like, within 10 minutes or 20 minutes. If you feel you cannot resist a post-meal nap, then fight for that recliner spot.

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison. The holidays are upon us – the season of sweets, treats, and big meals with family and friends. Unfortunately, holiday indulgence can take a toll on the digestive system. This week, Dr. Brad Kuo, Chief of the Division of Digestive & Liver Diseases at Columbia NewYork-Presbyterian, brings tidings of great gut health throughout all your festivities. From heartburn and bloating, to travel-sensitive digestive issues, Dr. Kuo shares a trove of practical tips for anyone looking to navigate the season with more cheer and less churn. 

Courtney: Welcome to the show. Thank you so much for being here today.

Dr. Kuo: Oh it’s my real pleasure.

Courtney: So today we want to spend a little time talking about the challenges people face around food during the holiday season, and talk a little bit about how we can celebrate without compromising our digestive health.

Dr. Kuo: Life is about compromise.

Courtney: Life is about compromise. So to get us started, what kinda symptoms do you hear about most this time of year?

Dr. Kuo: We do get an uptick of people wanting to find out advice from us uh during the holidays. Heartburn comes up because oftentimes the food that we eat is definitely different, uh, from our routine, probably on the more fatty and rich side because it is the holidays. They’re dealing with their in-laws or challenging family members or just converting somebody from being an introvert to having to deal with extrovert situations. And that results in abdominal pain, changes in bowel habits. 

Courtney: So what tips do you give people?

Dr. Kuo: So I think preparation is always the first step in dealing with things. And so, if there’s some experience knowing that under stressful situations, your bowels are gonna change, anticipate that. There are certain types of medications that we can give people to prevent any accidents or any stressful situations that mean you need to run to the bathroom unexpectedly. I think there’s other sorts of situations with regards to food. Oftentimes you ask the host, what are you going to serve? Or you might find it impolite, but I think preparation is key. For example, if you have a gluten allergy, if you have a lactose allergy, it’s worthwhile asking the host, are there any things to accommodate? And frankly, I think nowadays, these are things that hosts are more than willing to accommodate most of the time because frankly, they wanna make people feel as comfortable as possible. And if they can’t accommodate, it’s also worth asking, can I bring my own stuff just so that I can celebrate the most important thing, which is being together with people and not let food be a barrier.

Courtney: I love how you put that, that it’s not just about the food, it’s about being together, so communicating with your hosts, being prepared. And how might stress and travel during the holidays impact digestive issues, like constipation for example? 

Dr. Kuo: Sure. Well, I think the stressful situations which includes change of environment, whether it’s a change of time zone change or from your daily routines, this can cause changes in our internal clock and how our body deals with stress. You can imagine if you flew to the Far East from New York, you’re 12 hours different, you should be sleeping, but now you’re having all these feasts that you have to have with family gatherings. If your bowels are sensitive, that can really mess you up in terms of your bowel function. A couple things that are important is, you know, you have to think about how you can adjust your body to the time zone. Whether it’s melatonin or sleep adjusting a little bit before. You may be not having your, uh, regular amount of fiber intake, which can influence the amount of bowel movement frequency and consistency. If you know that you need to bring potentially fiber supplements to throw into some fluids, ’cause you know, you might be on the road and not getting your veggies that you’re used to taking. Beyond fiber, it might be helpful to take laxatives that can help promote bowel movements while your body’s undergoing the stressful changes of travel and social gatherings.

Courtney: It is so interesting that it seems like there’s a connection between stress and the bowels, and with your description of stress travel, you’re really describing a connection between the gut and mind as well as how the gut is part of your body rhythms. 

Dr. Kuo: Absolutely. It’s so interesting. Digestive health is something you take for granted. It is part of our daily function. We eat, we drink, and that’s supposed to provide not only nourishment, but also a sense of emotional wellbeing in terms of social gatherings or even in terms of pleasure that the food and drink give us. And these are fundamental aspects of existence. When they go awry, depending on the degree that they go awry, it can be totally and completely life shattering and life altering. And that further feeds into the cycle of stress and worry, then feeding back into the gut. And some people are afflicted by this tough cycle. But fortunately we do have options. If this is recognized ahead of time, there are certain types of approaches, both pharmaceutical-wise or even mind-body-wise that can make a dramatic impact on these sort of disorders. Meditation. Deep breathing can engage the vagal nerve system to calm the GI tract, decrease the sensations that may be triggered by anxiety or stress. The vagus nerve is a direct nerve from the brain to the gut, as well as the heart and lungs. It modulates the gut sensation. It is the relay that sends the signals from the gut to the brain and from the brain to the gut. So if you’re stressed, that vagus nerve is gonna be triggered in fight or flight that can cause all sorts of issues with your bowels. So calming yourself through the vagus nerve with deep breaths, slow deep breaths, actually decreases the vagal nerve tone, and can calm not only the mind, but also the bowels and the body.

Courtney: I think that’s fascinating ’cause when you think of stomach upset, you think of taking something for it, or maybe adjusting your diet, which not to say that you don’t need to do that, but deep breathing meditation – that’s such an interesting tip.

Dr. Kuo: It may seem simple to engage just taking a pill and hope the problem will go away. But we know from our own experience that it’s not always perfect. I’m not saying the deep breathing or stress reduction techniques is perfect either. The reality is these are bits and pieces of the puzzle, and you can actually mix and match these together to differing amounts to really make an impact on people.

Courtney: Are there any other natural remedies that people might try, especially through the holidays?

Dr. Kuo: Sure. So I guess a couple things. Peppermint helps loosen the bowel contractility. So that may help with cramps, that may slow down digestion a little bit, which may not be a bad thing. It does loosen the valve at the bottom of the esophagus called the lower esophageal sphincter, so you can be more predisposed a little bit to, to heartburn or regurgitation. But then many things that are called after dinner treats, whether it’s aperitifs with alcohol, coffee, tea, peppermints, actually all of these things reduce the lower esophageal sphincter tone and can predispose us to reflux. Now, the reality is a little bit of reflux is not a bad thing. You can relive your experience to the meal with a little bit of reflux, and that’s not bad. But when it’s really bad then and you feel pain, discomfort, a burning sensation regurgitation, then uh, I think that you might wanna be careful about the tea, the coffee, the alcohol, the peppermint that you take, after dinner mints, and really maybe prophylactically have antacid available, which can immediately neutralize the material. 

Courtney: You know, we’re talking about a few conditions here. Maybe it would help to just kind of break down – what’s going on in the body during heartburn and what causes it? And you’re also mentioning acid reflux. Maybe we could break down what the difference is, what exactly is happening for each of these things.

Dr. Kuo: Well, the reality is those two are almost synonymous. It’s just most people don’t talk about acid reflux at dinner parties, they talk more about heartburn. This heartburn issue comes up because when you eat, you have gastric contents, stomach contents, that stomach contents, uh, naturally can be regurgitated. As I said before, we all have a little bit of reflux throughout the day, more often after meals, and that is acceptable, and that is the way the GI tract vents the gases that build up. If we have carbonated beverages, air swallowing when we eat a meal, that’s all natural venting. But if a person feels an acid feeling with a acidic gastric context coming into their chest, they might feel a burning sensation. It may be a dull ache, it may be a burning sensation. It may be actually something more atypical like a post-meal cough or a little bit of hoarseness. That is all issues of mucosal secretions as well as stomach contents refluxing into the esophagus and maybe even as high as the back of the throat. And for the most part, if people experience that and can tolerate it once or twice, and it doesn’t happen daily or three times a week, it’s probably okay. You could just chalk it up to just what you ate that day. If it is a regular thing. If it’s occurring every day or several times a week and is causing some pause because of the sensation of burning discomfort or hoarseness or cough, then that is probably something that you should consult a doctor. A little bit of heartburn can be expected, that can be treated over the counter. If it’s regular or serious you should ultimately consult a doctor, get checked up because there could be bad things – a very small chance that very bad things could be happening down the line.

Courtney: And maybe we could talk a little bit more about what causes it. I think I know lots of what I might consider fun foods – coffee, chocolate, tomato – can cause it. If you could elaborate at all and what can someone do to manage it in holiday settings?

Dr. Kuo: Tea, coffee, peppermint garlic, onions – these all lower the esophageal sphincter tone and can predispose us towards a little bit of more reflux. But, spice is the, is an essence of life, and these are things that we have gotten used to. So if that’s the case, and you know these are gonna give you problems, I think it’s worthwhile to have a little either tablets or a little jug of antacids to take a swig if it bothers you that much. If you think it’s gonna be much more significant than just a little bit of antacids at the moment of, then I would take a H two blocker right before. And so if you are concerned prophylactically treating yourself or being a little bit more judicious about what you eat with regards to these food categories, but these are special times. This is all about festivities, and so you’re probably gonna indulge. If you know you’re gonna indulge, you just have to prepare a little bit ahead of time or expect that you’re gonna have these sort of changes.

Courtney: So how about another common one? Bloating. What is bloating? What causes it? How often are you helping patients deal with that?

Dr. Kuo: So bloating is extremely common, but it’s probably one of our least understood processes. Bloating is a sensation. I think there’s different flavors of it where you feel the sensation that your abdomen feels enlargened. It’s so interesting, some of the work being done on bloating shows that many patients, even though they look bloated when you measure their waist circumference, it’s actually not that bloated. Our current thinking about bloating, what’s happening is that due to some sort of reaction to the food or stimulus, all of a sudden the bowels get confused. And it causes a bloating reflux where the abdominal wall muscles relax. The back actually position changes the ceiling, the diaphragm and the bottom, the pelvic floor, all relax, causing a, in a stressed, panicked, state of relaxation, the sensation of bloating. It also, uh, may be mediated by the bowels being confused and then triggering nerve endings that give you the sensation of bloating even though you may not have visible distension. So that’s our current understanding of bloating. The reality is it’s common. More so in females. So, you know, what can we do about bloating? It’s not easy. The latest current thinking is if we know that it’s an abnormal reflex with the abdominal wall, with the diaphragm, with the pelvic floor, then it’s to do those type of things, remember I talked about the vagus, to sort of harness the nerve endings in the GI tract to calm them down. And so that is where deep diaphragmatic breathing to regain control of those wall muscles, bring them away from that shock state of bloating can be potentially helpful.

Courtney: I love how you described it before about the bowels being confused and then now we’re trying to calm our bowels down. It’s just a funny way to think of it. Can light exercise after meals, like walking or dancing, help to manage digestion?

Dr. Kuo: Sure. Digestion is a process that occurs on its own, with its own brain, but it can be modified by external factors, and exercise and being upright are also beneficial. So one of the key things about being upright after you eat particularly a fatty meal or a heartburn inducing meal is a lot of reflux, even if it happens, gets cleared because of gravity. And muscle contractions then helps the gravity clear the material. So one of the key things is if you’re eating and indulging, and you suffer from these sort of issues. Please don’t go to bed like within 10 minutes or 20 minutes. If you feel that’s going to, you cannot resist a post-meal nap after gorging yourself from the holidays, then fight for that recliner spot.

Courtney: Those recliners are usually taken at my family parties, but that is a good tip.

Dr. Kuo: Well then bring those lawn chairs. Bring the lawn chairs with the upright part so you can sack out upright. I’ve always wondered why are some of these holiday meals at two or three in the afternoon? Who eats at two or three in the afternoon and why are we doing this? But really, you know what, I see some wisdom in this. Have your big meal at three o’clock and so you go out there, take a walk with family, or a little football, tag football or something like that. Really get the bowels going, get the body moving, get the gravity going, and so that when it comes to 10 o’clock all that stuff will have emptied to put you at less risk for these sort of issues.

Courtney: Yeah, I think your aunt and uncle is right with that 2:00 PM Christmas start time.

Dr. Kuo: Yes

Courtney: Well, how about, can slowing down and eating mindfully make a significant difference?

Dr. Kuo: As you eat, and as the food is digesting in your stomach, it’s trickling down into your small intestines, and this is where a whole bunch of what we call endocrine reactions are happening. That’s where food is touching one part of the GI tract, the duodenum where absorption is starting to happen, and where the processing of fats and sugars are starting to happen. These send signals then through the bloodstream, to your brain, and these are very powerful signals. But that is something that doesn’t happen instantaneously. It takes time for after you eat to get that trickle into your small intestine to trigger these hormones, these powerful restrictors. So, if you eat very, very quickly, you can overwhelm your accommodation signal and just keep on pushing forward. If you eat more slowly, that gives more time for the material to get to your small intestine, to send those signals to your brain to really shut you down from eating more. And so by eating more slowly, you end up eating less volume til that signal happens.

Courtney: It is fascinating. Thank you for breaking this down. I’m just thinking of all those times when you’re really hungry and you eat too fast and then you feel awful and full after. Yeah.

Dr. Kuo: You’re exactly right, because that material hasn’t gotten into your small intestine to tell you to, okay, buddy, you’ve had enough of that third chocolate cake. You’re done. You’re done.

Courtney: Yeah. I wonder too, I think some of these events can be a little emotionally loaded, whether it’s going to a holiday party, maybe you have a little social anxiety or you’re going to a family party and there’s family dynamics. So I wonder, too, if it’s about preparing for some emotions that might be happening.

Dr. Kuo: Absolutely. So we talked about the brain-gut connection, and how stressful environments in these socially provoking situations can affect the bowels. I.e., if you know you’re lactose intolerant, taking three helpings of New York style cheesecake while you’re listening to family members argue about things, it’s probably not the best recipe for a happy bowel during the holidays. So in that regard, knowing that you may have to take deep breaths, make time for yourself, maybe a little bit of isolation away from the drama while you’re enjoying slowly what you enjoy that isn’t gonna provoke your GI tract, is all helpful.

Courtney: I think that is such great advice. . I just appreciate how it seems to come down to preparation, communication, mindful breathing, mindful eating.

Dr. Kuo: Well, I think that to understand that holiday gatherings is most about being together and making most of the time together. Food and dining helps with that experience, but it’s not the end all, be all. And understand your limitations and not let these things be a barrier by proper preparation, proper mindset, in terms of entering these situations.

Courtney: Thank you so much. This is terrific. I feel so much more prepared for my holiday gatherings this month. Thank you.

Dr. Kuo: Oh, my pleasure. Happy holidays.

Courtney: Happy holidays.

Courtney: Our many thanks to Dr. Brad Kuo. I’m Courtney Allison. Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Kuo’s work with patients, check out the show notes. NewYork-Presbyterian is here to help you stay amazing at every stage of your life. To get the latest episodes of Health Matters, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts.