Digestive Health Archive

Excess gas can be annoying, but is it cause for concern?

Gas is a normal — yet embarrassing — part of digestion. "We're all pretty gassy as individuals," says Dr. Kyle Staller, a gastroenterologist with Harvard-affiliated Massachusetts General Hospital.

In fact, the average person produces between 1/2 and 1 liter of gas every day and passes gas about 10 to 20 times. "While people may not like it when they do it, especially at inappropriate times, it's just a sign of a regular, healthy digestive system at work," says Dr. Staller.

You enjoyed the meal, but now you're paying for it. You've got heartburn—an uncomfortable burning sensation spreading through the middle of your chest. Sometimes the pain is so intense that you may think you are having a heart attack. Heartburn is one symptom of a digestive disorder known as gastroesophageal reflux disease (GERD), often called "acid reflux." In people with GERD, acid rises from the stomach into the esophagus, much like water bubbling up into a sink from a plugged drain.

Since diagnostic evaluations can be costly, doctors don't usually put people who have classic heartburn symptoms through these tests and proceed straight to treatment. However, worrisome symptoms, such as internal bleeding, swallowing problems, or severe symptoms that fail to respond to standard treatments, may warrant further investigation. Your doctor may recommend one or more of the following tests:

Allergic reactions or gastrointestinal distress are possibilities.

Your prescription pills contain more than just active ingredients to treat your medical condition. They're also full of inactive ingredients — additives with many jobs, such as helping a pill keep its shape.

Many of those inactive ingredients have the potential to cause adverse reactions, according to a Harvard study published March 13, 2019, in Science Translational Medicine.

Have trouble eating certain foods as you age? Here's what you can do.

Do some foods that you used to enjoy suddenly no longer agree with you? Do you often experience bloating, cramps, and pain that can vary in severity and duration and that come and go for no apparent reason? If so, you may have a food sensitivity, a digestive issue that becomes common as people age.

"Food sensitivity is simply a sign your digestive system is changing," says Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment at Harvard-affiliated Massachusetts General Hospital. "It can be physically unpleasant at times, but there are ways to manage this change without affecting your overall diet and ensure you keep getting the vital nutrients you need."

Ask the doctor

Q. I think I have heartburn, but I hear that what feels like heartburn is sometimes a more serious condition. How do I know if I have heartburn?

A. You've asked an important question. "Heartburn" describes symptoms caused by the reflux of stomach acid up into the esophagus (the tube that carries food from the mouth down to the stomach). It is a burning sensation. You can feel it high in the abdomen, just below the bottom of the breastbone, or underneath the middle of the breastbone in the chest. In other words, despite the word "heart" in the word "heartburn," real heartburn comes not from the heart, but from the stomach and esophagus.

Sales of cannabidiol-infused products are expected to top $2 billion by 2021. But is CBD right for you?

Cannabidiol (CBD) is touted as a natural wonder that can help treat symptoms of everything from anxiety to arthritis pain. The plant extract comes from two varieties of cannabis — hemp and marijuana — and is available in creams, tinctures, oils, patches, gummy bears, capsules, and more. You can even add CBD to a latte if you walk into a coffee shop in some cities.

But is CBD safe for older adults? There haven't been a lot of large studies of CBD's safety, but more traditional medicines for pain and anxiety are not free of adverse effects, either. "I think CBD is likely safer than many other treatments people use for pain, insomnia, or anxiety," says Dr. Peter Grinspoon, a primary care physician with Harvard-affiliated Massachusetts General Hospital. Other physicians don't think we know enough about the safety profile of CBD to be sure.

But these remedies aren't the best choice if you have frequent heartburn.

You feel the familiar sensation in your chest: heartburn. Again, you find yourself reaching for the bottle of antacids in the medicine cabinet. It's something you've done a few times a week for the past six months. Is it okay to keep popping over-the-counter acid reducers, or is it time to see a doctor?

We asked two experts, Dr. Jennifer Nayor and Dr. Molly Linn Perencevich, both instructors in medicine at Harvard Medical School, for their thoughts on heartburn, including when it's okay to use over-the-counter antacids and when you should seek other treatments. Below are their responses.

Ask the doctors

Q. I recently had diverticulitis. I'd like to avoid a recurrence. Is there anything I can do to prevent this painful condition in the future?

A. As people age, small pouches often form in the wall of the large intestine, a condition called diverticulosis. If food or bacteria become trapped in these pouches, they can become inflamed or infected, which is known as diverticulitis.

A muscular ring called the lower esophageal sphincter (LES) separates the esophagus from the stomach. Normally, the LES works something like a gate. The muscle relaxes when you swallow, opening the passage between the esophagus and stomach and allowing food to pass into the stomach. When the sphincter tightens, it closes the passage, keeping food and acidic stomach juices from flowing back into the esophagus. In people with acid reflux (gastroesophageal reflux disease or GERD), the LES relaxes when it shouldn't or becomes weak and doesn't close tightly. Either problem allows the contents of the stomach to rise up into the esophagus. The LES is controlled by various nerves and hormones. As a result, foods, drugs, and certain emotions such as anxiety or anger can impair its function, causing or worsening acid reflux. The following factors are under your power to change:

• Certain foods. Coffee, tea, cocoa, cola drinks, and other caffeine-containing products loosen the LES and stimulate gastric acid production. Mints and chocolate, often served to cap off a meal, can make things worse by relaxing the LES. Fried and fatty foods contribute to heartburn. Some people say that onions and garlic give them heartburn. Others have trouble with citrus fruits or tomato products, which irritate the esophageal lining. 
• Eating patterns. How you eat can be as important as what you eat. Skipping breakfast or lunch and then consuming a huge meal at day's end can increase pressure in the stomach and the possibility of reflux. Lying down soon after eating will make the problem worse.
• Smoking. Smoking can irritate the entire gastrointestinal tract. In addition, frequent sucking on a cigarette can cause you to swallow air. This increases pressure inside the stomach, which encourages reflux. Smoking can also relax the LES.
• Overweight and obesity. Being overweight or obese increases the odds of having GERD and experiencing heartburn. Actually, any weight gain increases the risk of frequent GERD symptoms. In addition, eating larger meals distends the stomach, pushes the contents up toward the esophagus and loosens the LES.
• Certain medications. Some prescription drugs can add to the woes of heartburn. Oral contraceptives or postmenopausal hormone preparations containing progesterone are known culprits. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) can irritate the stomach lining. Other drugs—such as alendronate (Fosamax), used to prevent and treat osteoporosis—can irritate the esophagus. And some antidepressants, bronchodilators, tranquilizers, and calcium-channel blockers can contribute to reflux by relaxing the LES.

To learn more about GERD and heartburn, read Controlling Heartburn from Harvard Medical School.