Gut Reactions
Reviewed by Toni Martin, MD
CONSUMER HEALTH INTERACTIVEFreedom from Digestive Distress: Medicine-Free Relief From Heartburn, Gas, Bloating and Irritable Bowel Syndrome
By Gary Gitnick, MD with Karen Cooksey
Three Rivers Press
Paperback 288 pp $14 
The first thing I liked about this book was the choice of the word "distress" in the title. It immediately established the author Gary Gitnick as a compassionate doctor. It's true that the conditions he discusses don't carry the threat of mortality the way cancer or coronary artery disease do. Yet gas, heartburn, constipation, and diarrhea can wreak havoc with our bodies, causing tremendous physical and emotional distress. To a patient suffering from irritable bowel syndrome so severe that he's embarrassed to go on social outings, the desire for relief can be overwhelming. One out of every four visits to a primary care doctor, in fact, is due to a digestive problem, according to Gitnick. He himself is a gastroenterologist, a specialist in diseases of the esophagus, stomach, intestines, liver, and pancreas, all the organs that contribute to digestion. As chief of the Division of Digestive Diseases at the University of California at Los Angeles School of Medicine (the largest gastroenterology division in the world, according to the book jacket), he has heard the full gamut of complaints. Many of his patients reported repeat episodes of searing heartburn, especially if they had eaten late at night. Others had had "nervous" stomachs since they were children, but were never properly diagnosed as having irritable bowel syndrome until Gitnick saw them. One patient had experienced excruciatingly embarrassing bouts of gas, bloating, and cramps all his life -- until he took up exercise, improving both his health and his self-esteem. Trouble-free digestion
Although he spends his professional life looking up and down the gastrointestinal tract with fiberoptic endoscopes, Gitnick believes that the secret to a healthy GI tract lies outside the body. Echoing the heart doctors who advocate lifestyle changes to prevent heart attacks, he tells us that a healthy lifestyle also promotes trouble-free digestion. He urges people to give up smoking to avoid swallowing air and inducing heartburn, in the short run, and to decrease the risk of cancer of the esophagus and pancreas, in the long run. He advocates regular exercise to minimize bloating and cramping. Weight loss, he points out, will help keep acid from the stomach from refluxing back into the esophagus and causing heartburn. He suggests that meditation is a healthier way to cope with stress than alcohol. Most of this advice is so familiar that it is a wonder anyone has missed the message. If the cardiologists haven't been able to get America on the program, will the gastroenterologists fare any better? The one advantage Gitnick has over heart doctors is that most of the time he is not urging change to prevent the risk of a problem many years hence. His advice is for immediate relief: Don't lie down after eating pizza, he tells us, because we'll get heartburn that night, and if we eat a lower fat meal and take a walk, we'll feel better here and now. Gitnick recommends that his patients keep an eating diary, because he often finds that people are not aware of the ways their routine differs when they have symptoms. "I sent [a patient] home with the assignment to begin writing down everything about everything she ate in her food journal: the time of day, the place, what she ate, how she felt -- both physically and emotionally -- when she ate it, who was with her, and how she felt after eating." The woman he was instructing felt that food stuck in her chest on certain days. After keeping a record, she realized that on the mornings she sat down at the computer, she ate doughnuts, drank coffee, and smoked cigarettes. Those were the days she felt the lump in her chest. On the mornings she cared for her grandchildren, she ate low-fat cereal and milk with them and walked them to the bus stop. She had a rule that she didn't smoke around the children. On those days, she felt fine. Difficult changes
Sounds pretty obvious, doesn't it? That's Gitnick's point. If we sit a minute and examine what we're doing, we can often figure out how to prevent our symptoms without medicines. He describes another woman who started a walking program and worked up to a 30-minute stroll each night. He was surprised she didn't lose weight -- until, that is, "she admitted that that she had been walking to a neighborhood ice cream parlor and getting a double-scoop chocolate fudge cone each night to enjoy on the trip home as a reward for herself." On some level, she probably knew that eating ice cream on her walk didn't make sense, but change is hard and ice cream is sweet. Of course, some diseases like ulcerative colitis and diverticulitis do require treatment with medications. Although a change in lifestyle can also help these conditions, people with these problems need to stay under a doctor's care. For every person with ulcerative colitis, however, there are hundreds more with heartburn or irritable bowel syndrome who will benefit greatly from Gitnick's commonsense advice. When it comes to digestive distress, we're our own worst enemy. -- Toni Martin, MD, is a board-certified internist and geriatrician based in Oakland, California who has written for Hippocrates magazine. She is also a teacher and member of the clinical faculty at the University of California at San Francisco Medical School.
Reviewed by C.E. McLaughlin, MD, a professor of sports medicine at the University of California at Berkeley.
Our reviewers are members of Consumer Health Interactive's medical advisory board.
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First published January 24, 2002
Last updated December 4, 2007
Copyright © 2002 Consumer Health Interactive
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