Belly doing flip-flops again? For most people, abdominal upset is an occasional fact of life. “It affects 
everyone some of the time, and some people all of the time,” says Victor Sierpina, MD, professor of family and integrative medicine at the University of Texas Medical Branch, and author of The Healthy Gut Workbook (New Harbinger, 2010). In fact, one in three adults has a digestive disease, such as irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), food intolerances, or leaky gut syndrome. The rest of us have periodic bouts of heartburn, diarrhea, constipation, gas, and bloating.
To understand why tummy troubles are so common, try to visualize this: The gastrointestinal tract—mouth, esophagus, stomach, small and large intestines—has an absorptive surface the size of a tennis court. “It’s one of the major routes where the outside world meets the inside of our body,” says Angelica S. Vrablic, PhD, manager of nutrition research for NBTY, a dietary supplement manufacturer. It’s exposed to toxins, allergens, viruses, and bacteria, as well as food. Good thing, then, that 70 percent of immune cells are in the GI tract, ready to defend against anything that comes in. The downside to this hypervigilance is that the digestive system’s reactions to invaders—real or perceived—often cause unpleasant symptoms.
Aging tends to aggravate the situation: Declining production of stomach acid—which helps activate enzymes—tends to mean weaker digestion. Ironically, you feel stomach acid more as you get older. “The valve between the stomach and esophagus gets weaker and floppy,” Vrablic says. This lets stomach acid splash up, leading to heartburn and reflux. Proton pump inhibitors—drugs like Prevacid and Prilosec—tend to worsen the cycle, and should be taken only as a last resort. Blocking stomach-acid production relieves irritation and may give the GI tract a chance to heal, but it also allows bacterial infections to thrive (which means food doesn’t get broken down as well) and may lead to more serious problems.
Digestive issues aren’t just uncomfortable—they affect your total well-being. Take IBS. Although there’s no known cause for this inflammatory condition, 14 percent of the population lives with its hallmark symptoms: chronic abdominal pain, bloating, and alternating diarrhea and constipation. Or consider leaky gut syndrome. Any number of factors—stress, food allergies, heavy alcohol use, infections, medications such as antibiotics and nonsteroidal anti-inflammatory drugs like ibuprofen—can damage and inflame the gut’s lining, allowing undigested food molecules to pass directly into the bloodstream. Not only does the body not absorb nutrients from these large molecules, but the immune system begins attacking them as bloodstream invaders, stimulating inflammation and allergic reactions elsewhere in the body. “The prevalence [of leaky gut] is underestimated,” Sierpina says, “and it causes or worsens many conditions”—especially autoimmune ones like rheumatoid arthritis, lupus, chronic fatigue, and psoriasis.
“If digestive health is not in balance, you’re not going to feel well, and you may have systemic consequences,” says North Carolina–based Liz Lipski, PhD, CCN, clinical nutritionist and integrative health consultant, and author of Digestive Wellness, Fourth Edition (McGraw-Hill, 2011). “It’s an opportunity to look more deeply.” Here, you’ll find guides to common digestive issues as well as healthy habits and supplements that can help get your digestion—and wellness—back on track. Keep in mind that digestive symptoms are similar for many conditions, and can also indicate something more serious, so consult your health care provider if symptoms persist and before taking any dietary supplement.
Decrease stress. Stress can spike inflammation, increase indigestion, and worsen existing digestive conditions. To reduce stress, make a point to exercise, eat a balanced diet (see below), develop a spiritual practice, cultivate a support network, and get plenty of sleep. Try deep-belly breathing for general relaxation and to control anger and anxiety, says Sierpina.
Downsize meals. Trick yourself by using a salad plate, and eat until you feel almost full.
Don’t eat before bedtime. Lying down with a full stomach can push stomach contents back toward the esophagus, resulting in reflux, Vrablic says.
Eat more fiber.“The average person gets about half as much fiber as she should,” Lipski says. Aim for 25 to 30 grams daily. It encourages more regular bowel movements, keeps blood sugar more even, and acts as fuel for probiotics.
Adopt a Mediterranean diet. Focus on anti-inflammatory, fiber-rich whole grains, fruits, and vegetables. (If raw vegetables give you trouble, cook them before eating.) Choose lean proteins and healthy fats, including cold-water fish, like salmon. Eat red meat infrequently.
Eat bananas. “They’re soothing and have an anti-inflammatory effect on the gut,” which is helpful for GERD, says Sierpina.
Eat mindfully. “When we say grace, it stops us and says, ‘I’m here eating, and I’m thankful for this moment,’” and also helps lower our heart rate, blood pressure, and stress levels, Lipski says. Notice the color, the aroma, and the texture of each bite before placing it in your mouth, Sierpina recommends. Try this for one meal a day, until it becomes habitual.
Chew food well. You’ll activate enzymes in your mouth that help break down carbohydrates, giving stomach acids time to work and minimizing the burden on the rest of the GI tract.
Try an elimination diet. If you think you have a food sensitivity, keep a food diary for at least three days, recording everything you eat and any effects you notice. Symptoms may come on rapidly, or may not manifest for up to 12 hours. Once you’ve identified the most likely food culprits, eliminate them for two to three weeks, Sierpina suggests. If symptoms improve, gradually add the foods back in, one at a time. Eat the test foods at least twice a day, he says.
Enzyme deficiency: The body produces specific enzymes for dairy, protein, fats, and carbohydrates. If you don’t make enough of one (dairy-enzyme insufficiency is common)—or if you don’t have enough stomach acid to activate them—you’ll experience gas, bloating, and diarrhea when you eat that food.
Food intolerance or sensitivity. People who are sensitive to gluten, dairy, eggs, nuts, seafood, or other foods may have abdominal cramping and diarrhea after consuming those triggers. Symptoms may also be subtler, and include fatigue, itching, brain fog, dark circles under the eyes, migraines, or nasal congestion.
Gastroesophageal reflux disease. GERD is diagnosed when you have frequent and chronic heartburn or reflux—when acid and other stomach contents splash back into the esophagus and create a burning sensation in the abdomen, chest, or throat.
Irritable bowel syndrome. IBS is often diagnosed when docs can’t find any other reason for chronic bouts of abdominal pain, bloating, diarrhea, or constipation.
Leaky gut syndrome. You get frequent diarrhea, and you also seem to get more than your share of colds, low-grade fevers, body aches, chronic fatigue, and other infections. When you do get sick, it takes you longer than most to heal. You may also have anemia and other nutrient deficiencies.
Gut-supportive supplements
Aloe vera gel. It’s rich in mucopolysaccharides, effective anti-inflammatory agents that are treat GERD, gastritis, leaky gut, and other conditions. Dose: 2–3 ounces daily of a product containing standardized mucopolysaccharide amounts.
DGL. Deglycyrrhizinated licorice soothes the esophagus and stomach and acts as an antacid. Helps with GERD. Look for chocolate flavors, to make chewing more pleasant. Dose: 2–4 380-mg tablets, before meals.
Digestive enzymes. Helpful for gas, bloating, and lactose intolerance; check labels for enzymes that work at a range of pH levels, “so they can get the job done irrespective of gastric-acid production,” Vrablic says. For general support, choose a product with several types that help digest proteins, fats, carbohydrates, and fiber. For food sensitivities, try targeted products with lactase (for dairy) and specific proteases (for gluten and casein). A few enzymes can be animal-derived, but you can generally find vegetarian ones, too; check labels. Dose: One capsule, taken at the start of a meal.
Glutamine. This amino acid helps repair damaged intestinal cells, helpful for leaky gut. Dose: 1,000–3,000 mg three times daily. Back off to a lower dose if you start to get constipated.
Probiotics. Probiotic supplements restore beneficial bacteria lost after bouts of diarrhea, antibiotic use, or poor diet. They’re helpful for lactose intolerance, IBS, leaky gut—and balancing the immune system. Lipski often recommends Lactobacillus acidophilus and Bifidobacteria bifidum strains; in animal studies,B. bifidum improves mucosal barrier function and decreases inflammation, helpful for leaky gut. Dose: 1 billion–25 billion live organisms daily.