Holiday Gift Guide for the Digestively Disturbed

We all know (and love) someone who's got... issues. The constantly bloated belly... the repeat trips to the bathroom...the restricted diet born of a sensitive stomach. These friends need to know we've got their backs, and nothing does a better job of conveying this message then a thouhtfully procured gift.  Here are my picks for the 2017 season:


Gluten-Free Goodies

Your sad celiac friends are always left out of the Christmas Cookie Swaps and homemade office kitchen treats. These indulgent baked goods ship nationwide, and can help turn your beloved gluten-free friend's frown upside down.

Low FODMAP Cookbook

The low FODMAP diet has probably helped someone you know with IBS feel markedly better, but the diet can come at a price: boredom. If your bloated friend is growing weary of grilled chicken with zucchini for dinner... again... treat him or her to the latest and greatest from veteran recipe developer Dede Wilson and dietitian extraordinaire, Kate Scarlata. 

The Low FODMAP Diet Step By Step (~$16 on Amazon)


Pukka Organic Digestif Teas 


The five teas that comprise Pukka's Digestif collection have such gorgeous packaging that no recipient could possibly be embarrassed about being gifted one (or more) of them. The teas in this range feature organic herbals known for their digestively soothing properties, like mint, fennel and licorice. Throw in a fancy mug and you've got yourself a gift. (Skip the chicory-containing 'After Dinner' product if your recipient is prone to gas, though, and avoid gifting licorice containing varieties to pregnant women.)

Pukka Teas, ~$6/box of 20 teabags




Squatty Potty


A more intimate gift best reserved for good-humored siblings and your closest of confidantes, the Squatty Potty can be a helpful bathroom accessory for those who struggle with constipation. It's a stepstool that's shaped to hug your standard toilet, enabling one to achieve the optimal anatomical pooping position. The company's holiday gift bundle also comes with a set of before-you-go sprays to help keep maintain a fresh and festive bathroom ambience, and the stools are available in a variety of materials and colors, from white plastic to teakwood to a translucent acrylic that looks straight out of a Kartell Modern catalog.

Squatty Potty, from $19.99-$79.99


Disclosure note: I have no material affiliations with any of the companies whose products were featured in this blog post

You asked: "Will a Digestive Enzyme Supplement Help Reduce My Bloating?"


There’s a lot of confusion surrounding digestive enzyme supplements, and all sorts of people seem to take them for all sorts of reasons. But whether or not you’re likely to benefit from one depends on what your digestive problem is, and what type of enzyme you’re supplementing.


So let’s start with the basics: what is an enzyme?

An enzyme is a protein that facilitates a particular chemical reaction. In digestion, our bodies produce a wide range of different enzymes to facilitate the chemical breakdown of different food components into their smaller, absorbable building blocks.


The important thing to understand about enzymes are that they’re very specific to a particular type of biochemical reaction.  In other words, a protein-digesting enzyme—called a protease—cannot break down things that aren’t proteins, like carbohydrates, fats, sugars or fiber. And even within the family of protein-digesting enzymes our bodies produce, different proteases are designed to break down different components of proteins we eat. For example, certain proteases break down the chemical bonds between protein building blocks toward the end of a protein’s chain, whereas others break bonds toward the center of a protein’s chain.

Without getting too mired down in biochemistry here, the first point I’d like to make is this: an enzyme will only help you improve digestion of a food if it’s the right enzyme for the right type of food.

Which brings us to the next question: is poor digestion of certain foods in your diet the cause of your bloating? And if so, which enzyme(s) supplements would target the poorly-digested food in your diet effectively to help alleviate your symptoms?

The most common causes of digestive symptoms from poor digestion and absorption of nutrients are from the following nutrients:

·      Lactose, a natural sugar found in milk

·      Fructose, a sugar found in certain fruits and sweeteners, and also added to processed foods

·      Oligosaccharides, components of fiber commonly found in certain vegetables and beans that we humans don’t make enzymes to break down

Less commonly—but certain not uncommonly--incomplete digestion of fat can cause digestive symptoms. This generally occurs in people with a condition called pancreatic insufficiency, in which their pancreas isn’t able to produce or secrete enough of the fat digesting enzyme lipase to get the digestive job done.  (People who don't digest fat well are more likely to complain of foul-smelling diarrhea, toxic smelling gas and weight loss in addition to mere 'bloating,' though.)

It is exceedingly rare for people to have trouble digesting sugar in the form of sucrose (table sugar) or glucose and simple starches (maltose, amylose). These are among the most rapidly and easily absorbed nutrients…even among people whose pancreas function is impaired. Enzyme supplements targeted at breaking these nutrients down are a waste of money.

It is also not very common to experience gas and related bloating from poor digestion of proteins (including gluten) and certain types of plant fiber like cellulose.  This is because the gas-producing bacteria living in our guts aren’t particularly well-equipped to ferment these nutrients, even when we don’t digest them.  Enzyme supplements targeted at breaking these nutrients down aren’t likely to alleviate much gas or bloating.

Hopefully, this introduction helps explain my approach to the question of digestive enzyme supplements, which is:

The ones most likely to help reduce symptoms of gas, bloating and diarrhea related to poor digestion of nutrients are those which are specific to helping us digest those nutrients most likely to cause digestive distress:

·      Lactase enzyme, when taken just before eating lactose-containing dairy foods

·      Xylose isomerase, when taken just before eating fructose-containing fruits, juices and sweetened foods

·      Alpha-galactosidase, when taken just before eating veggies in the cabbage family (broccoli, Brussels sprouts), beets, lentils, beans and chickpeas

If digesting fat gives you trouble due to problems with your pancreas, then the dose and delivery of lipase enzyme contained in your typical non-prescription enzyme supplement may not get the job done. It’s important to discuss prescription lipase options with your doctor to ensure you’re getting a standardized supplement that will enable you to absorb both fat—and all the fat-linked vitamins you need to meet your needs.

All of the other enzymes commonly contained in dietary supplement products are either redundant to your body’s own very unlikely-to-be-impaired production—or unlikely to reduce symptoms of gas and bloating, since the foods they help digest don’t generally cause gas and bloating to begin with. I regard the following enzyme supplement ingredients to be pretty useless in managing digestive distress in uncomfortable but otherwise healthy people:

·      Amylase

·      Maltase

·      Invertase

·      Protease

·      Peptidase

·      Trypsin

·      Cellulase

·      Hemicellulase

·      Phytase

·      Bromelain

·      Papain

·      Ox bile

·      Betaine Hcl





Oral Allergy Syndrome


If certain raw fruits and vegetables make your mouth, tongue, throat or inner ears itch, you may have Oral Allergy Syndrome (OAS).  

OAS is what happens when you've got seasonal allergies and your body accidentally confuses the proteins on raw fruit with the pollen proteins its supposed to be allergic to. Basically, its a seasonal allergy masquerading as a food allergy. 


OAS differs from classic food allergies because the majority of people don't react to the fruit when it's been cooked. In other words, raw apples may give your mouth grief, but applesauce often goes down without a hitch.  Same goes for raw stone fruits versus fruit pies, raw carrots versus cooked ones or raw pears versus poached ones. Some lucky folks can even get away with eating their trigger food raw so long as they peel it.

It's rare-- though certainly not impossible-- for OAS to cause anaphylaxis like a more typical food allergy does. Still, pay attention to your symptoms and take action if your reaction spreads beyond an unpleasant itchiness in the mouth or throat. If you can't tolerate even the cooked form of the fruit-- or if nuts trigger an oral reaction-- you should avoid the trigger food(s) and see an allergist for proper food allergy testing.

The food(s) you react to with OAS will depend on what seasonal allergen you're allergic to, and your food reactions will likely be more severe when you're in the midst of allergy season. Certain fruits, veggies and even nuts can "cross react" with pollens whose proteins resemble theirs.

If you're allergic to birch pollen (Spring), you may experience OAS with: apples, pears, stone fruits (peach, plum etc), kiwi, carrots, celery, peanuts, almonds and/or hazelnuts.

If you're allergic to ragweed (Late summer/Fall), you may experience OAS with: melons, cucumber and zucchini

If you're allergic to grasses (Summer), you may experience OAS with: peach, watermelon, orange, tomato, 

If you're allergic to mugwort (Fall), you may experience OAS with: raw veggies, like pepper, broccoli, cabbage, cauliflower, chard, garlic, onion and parsley

IBS 101: The Two Supplements Everyone with IBS Should Know About

Irritable Bowel Syndrome (IBS) affects 10-20% of the U.S. population... and about 80% of my clinical practice's patient population. For the better part of the past decade, I've basically been living and breathing IBS in all of its forms vicariously through my patients. I know all about the incessant morning trips to the bathroom with IBS-D... the days without any activity in the bathroom with IBS-C... and the IBS-M cycles of not being able to go for days, followed by an entire day spent running to the bathroom once the "dam breaks." 

There are many approaches to managing these symptoms of IBS-- from elimination diets to probiotics to other supplements to prescription medications to hypnotherapy.  At one time or another, I've recommended all of these in my practice, tailoring my advice to a patient's individual pattern of symptoms. 


But there are two remedies that have been the most effective for the largest number of my patients over the years: soluble fiber supplements for IBS-D and magnesium supplements for IBS-C. They're cheap, over the counter, sold everywhere, and in my humble opinion, should be the first thing you try before diving deep into the rabbit hole of expensive, extensive treatment protocols.

Citrucel and Benefiber are my soluble fiber products of choice. Taken every evening at the recommended 2g dose, they are often remarkable effective at normalizing the morning routine among people with IBS-D-- consolidating those multiple, urgent trips to the bathroom to just one or two efficient visits and forming those loose and crampy stools into bulky, complete and easy-to-pass alternatives. A full dose of Citrucel is 4 pills or 1 TBSP (orange flavored) powder. A full dose of Benefiber (unflavored) is 2 tsp. Both are equally effective. The most common way my patients describe soluble fiber therapy is "life changing."

For constipation predominant IBS, magnesium supplements at a dose of 400-800mg, also taken in the evening, can be remarkably effective in softening stools and increasing their frequency. Any old form will do, though magnesium oxide is the one you'll encounter most often. I'll usually have my patients start at 400mg and work their way up-- 200mg at a time-- if needed. Take the full dose all at once. Assuming you've got functioning kidneys, the only real side effect you need to worry about at this dose is diarrhea. If that happens, pull back on the dose to find that happy middle ground.