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From heart-burn to wind
Janet Gray explains the vagaries of the human digestive system
“We are what we eat” – so the old adage goes, so maybe it is not surprising that many people have problems with their digestive system. These problems can vary from a bit of indigestion occasionally, to serious and incapacitating inflammatory bowel disease.
Perhaps to start with it is instructive to look at the sort of foods that man evolved to digest. Primitive men were hunters and gatherers, so this meant meat, when the hunters were in luck; fish, depending on where they lived; and roots and fruit, depending on the season. Grains were not cultivated until much later, so many doctors and nutritionalists feel that this so-called “stone-age” diet is the one that the human system can best handle. Along with the cultivation of grain crops came the domestication of cows, with dairy products becoming incorporated into man’s staple diet, although these are certainly not “natural” foods for humans.
Now all this is not to say that only meat, fish, fruit and vegetables should be eaten, and not grains or dairy products, because there are many people who have cast-iron stomachs, and these foods present no problems at all. I am simply pointing out a possible starting point for those who do find they have trouble with their digestion and first we have to be clear what is meant by indigestion.
What one person means may be poles apart from another person’s complaint. One patient may be meaning heart-burn, whilst another may be embarrassed at describing an excess of wind from the back passage!
So the first task is to take a really good history and find out exactly what it is that is troubling the patient, along with the modalities (qualifying factors) of the condition.
Jeff came to see me very disenchanted with his own doctor. He had had “indigestion” for years and investigations had shown up a hiatus hernia, for which he had had conventional treatment, but the symptoms had not been controlled. Immediately after a meal he would develop a severe pain under his left ribs, with a lot of wind. The pain was relieved by passing the wind. He also had a separate complaint of heart-burn, which developed some two hours after a meal, and he had noticed it was much worse if he ate bread (which he loved). After more direct questioning it transpired that he was upset by fats and pickles, although he liked both. Sweet things did not cause problems, but he disliked spicy foods and curries. He was an anxious man, and admitted to being a perfectionist, but he was very emotional and had not really ever got over the death of his father.
So here was a very complicated picture, with two different pathological diagnoses – hiatus hernia and irritable bowel syndrome – but he just regarded it all as “indigestion”. No wonder his own GP could not sort him out – only a holistic approach, such as homeopathy, would be likely to make any headway.
I treated him with a combination of diet (excluding wheat and dairy) and homeopathy, but even so, it took me a while to get him symptom free. The bowel nosode, Dys co, did the trick in the end, so much so that he is now able to eat wheat without any problems!
This is usually, but not always, associated with the presence of a hiatus hernia, causing acid to reflux up the oesophagus (gullet), causing a burning sensation in the chest. A hiatus hernia is simply an anatomical variation, present from birth, possessed by about 30 per cent of the population. The stomach should normally sit just below the diaphragm so that the muscles of the diaphragm act as a sphincter(the cardiac sphincter) to close off the top of the stomach and prevent its contents refluxing back up the oesophagus. If a hiatus hernia is present, the stomach in effect has no method of closure, and so acid and other stomach contents are easily regurgitated.
This is often the cause in a baby who regularly throws up its last meal, and is immediately hungry again. The baby is however perfectly healthy, and the problem is not solved until the child gets on its feet and walks! Gravity then keeps the stomach contents in place. I have found Aethusa helpful in such cases, especially if there seems to be an intolerance of milk.
In an adult, a hiatus hernia may not cause any problems unless the person becomes overweight. Then the increased intra-abdominal fat will push up the stomach, worsening the propensity to reflux. This is obviously worse lying down and on stooping, because gravity is no longer able to help the stomach contents to stay down. Acid is secreted by the stomach mucosa (lining of the stomach) to digest the food, so stomach contents are always very acid – it does not take long, therefore, before the walls of the oesophagus become “burnt” by the action of the acid, causing the typical pain of heart-burn. The stomach is lined by cells, which are usually acid-resistant, but the oesophagus has no such protection.
A classical situation is an over-weight person who is woken at two in the morning by a severe burning pain behind the sternum, who has to sit up and take a dose of an antacid to neutralise the acid, and thus relieve the pain. The pain can be so severe as to mimic a heart attack. Advice should always be given about weight loss, and raising the head of the bed to assist gravity in its work.
Graphites – for a person who is overweight and has a rather lazy temperament. They often have rather coarse skin, and indeed often suffer from skin problems. They are rather greedy, which is a problem for weight loss, but are averse to meat. They get a constricted feeling soon after a meal and have to loosen their clothes. Unusually, their pain is relieved by lying down, so this feature is useful in keynote prescribing.
Pulsatilla – indicated for someone with the changeable, emotionally demanding attitude typical of the remedy. Their indigestion comes on straight after a meal too, and they are upset by a lot of foods, especially rich sauces cooked with cream and butter, pastries and pork. They are thirstless, which is a useful prescribing feature.
This describes the sort of pain one would experience if suffering from gastritis (inflammation of the stomach) or actual peptic ulceration. The pain is located centrally just below the sternum, known in medical jargon as the epigastrium.
When the integrity of the lining of the stomach has been breached, it becomes open to acid-damage; this can be due to infection by a bacterium called Helicobacter pylori (H. pylori) or by an excess of acid secretion. Research is still progressing as to the cause and significance of an infection by H. pylori, and to the best regime of treatment.
The pains of dyspepsia are often sharp in nature, and are due to acid coming into contact with either a raw surface in the stomach or an actual ulcer. Gastritis is the stage before ulceration when the gastric mucosa is simply inflamed and raw because of the action of the acid, but not actually ulcerated.
The pain is often at its worst when the patient is hungry, as there is no food in the stomach to absorb the acid, and then again a few hours after eating. It is often relieved by food or by antacids. The conventional treatment is by H2 (histamine 2) antagonists, such as Cimetidine, which stop the secretion of the acid. This often renders the patient pain-free very quickly, but unfortunately we need our acid to digest our food, so the patient may run into other digestive problems in the long term. The patient may also be given H. pylori eradication therapy, if they have tested positive to the bacteria, involving strong doses of antibiotics, which cause their own problems!
Nux vomica is a remedy par excellence for this sort of problem. High-powered business executives, who do not have time for regular meals, who may drink and smoke to excess (which encourages over-secretion of gastric acid) and who are highly stressed, and get irritable and angry easily (encouraging more acid secretion) are prime candidates for gastric ulceration. They are often thin, active and on the go the whole time and suffer also with constipation.
Arsenicum album – particularly good for fastidious, rather up-tight people who get dyspepsia after pickles, acids and fruit, and also from very cold foods, such as ice cream. They may wake in the early hours with their symptoms, which are nausea and vomiting, with burning pain in the epigastrium. They are extremely anxious individuals, who worry about everything and cannot relax.
This causes of a lot of distress, although it is not associated per se with any serious disease. Patients are often very vague as to what they mean by “wind” and, on pinning them down, it may vary from painful distension, without actually passing any wind, to the embarrassing passage of wind either from the rectum or by belching. This may or may not be associated with abdominal pain. In fact, the production of gas in the intestine is a normal accompaniment of digestion, because there are “good” bacteria living in the bowel whose job it is to ferment the food, thus producing gas as a by-product. If these bacteria are killed as a result of antibiotic treatment (which kills all bacteria, good and bad), the result is often diarrhoea and over-colonisation by other organisms, such as Candida. Thus it is always advisable when taking an antibiotic to take some natural yoghurt or acidophilus capsules.
Excess wind production may be due to the dietary content, with foods such as onions and Brussel sprouts classically producing rather a foul smelling gas. Too much refined sugar also increases gas production, as the bacteria are being given a perfect substrate for fermentation. It is impossible to define what is “normal” gas production, so the patient often simply needs to be given some dietary advice, reassurance that all is well.
However, if the distension is causing pain, then clearly some help is needed.
Lycopodium is the other great “indigestion” medicine especially when there is abdominal pain, particularly in the right lower abdominal region, with distension and an excess of wind passing per rectum. The sufferer is often highly stressed, but in a different way, and for different reasons than the Nux vom patient. A Lycopodium type sets very high personal standards and must meet them. They lack self-confidence, but cover it up very well, often appearing outwardly rather arrogant. However this is all a front, and their inward anxiety is often manifested as gut problems.
Carbo vegetabilis is particularly good for the over-weight dyspeptic who suffers a great deal of distension with pain and wind, relieved (temporarily) by belching. These are very sluggish people, with a slow digestion. They are intolerant to fatty food and also milk.
Digestive problems are often amenable to self-treatment. However it is important to bear in mind that these symptoms, especially if new to a person or if associated with weight loss and change in bowel habit, may be markers of serious disease, so a medical opinion must always be sought.
Janet Gray MA MBBCh FFHom DRCOG DFFP, a GP for over 20 years, has used homeopathy in her Bristol practice for some 15 years. She lectures in homeopathy at the Bristol Teaching Centre and has a small private practice near Chippenham.