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Gastrointestinal Myths with Dr. Jonathan Gotfried

Commentary
06/10/2020 Jonathan Gotfried, MD, Lewis Katz School of Medicine at Temple University| Main Line Health, Bryn Mawr, PA;

Season 2 | Episode 3

 

 

 

>> Dr. Gotfried: I was just on an airplane, and we gave gum to my three-and-a-half-year-old for the first time ever, and he dutifully chewed it for three seconds and then swallowed it. And so, he didn't know any better. But my eight-year-old looked at me terrified, said that he had done something very wrong and that we wouldn't be able to retrieve the gum until my three-year-old was ten.

 

>> Joe: Welcome to the Merck Manuals Medical Myths podcast, where we set the record straight on today’s most talked about medical topics and questions. I'm your host, Joe McIntyre, and on this episode, we welcome Dr. Jonathan Gotfried. Dr. Gotfried is from the Lewis Katz School of Medicine at Temple University in Philadelphia. He specializes in GI and gastroenterology, and is the Director of Patient Safety and Quality Assurance at the Temple Digestive Disease Center. Dr. Gotfried also authors the GI sections of the Merck Manual. Today, we’re going to talk to him about some of the most common myths surrounding your stomachs, guts and everything in between. Dr. Gotfried, thank you for joining us.

 

>> Dr. Gotfried: Thank you so much for having me today.

 

>> Joe: Alright, so first let's begin with a question we see a lot around the earlier part of the year and approaching the summer season as well, when people want to get their bodies in shape. I'm talking of course about detoxes and, specifically, a colon detox. So, are there any actual benefits of doing a colon detox, doctor?

 

>> Dr. Gotfried: So, it’s a great question, and this is something that a lot of my patients always come in asking me about. And, interestingly, when we want them to do a purge before their colonoscopy, that’s something they kick and scream about, and that they don't want to do. But when it comes to do a colon detox, it's the rave that everyone wants to be involved in and see if it would help them. My knowledge of colon detox is as much as it seems that the scientific community knows which is that there is no known health benefit that a colon detox. I think though it’s helpful for us to understand what a colon detox is and what people mean by it. There's many ways of doing a colon detox that I’ve seen patients come in asking about. A lot of them will use an irrigant, where they are drinking a lot of water or taking a laxative. Some people use different teas or enzymes that help them have bowel movements to quote detox their colon. But as far as my knowledge of the literature, there's no health benefit, and there’s actually a potential for a harm in doing a colon detox, and so it's not something that we typically recommend patients doing.

 

>> Joe: So, when it comes to a liquid diet, what's the difference there, and are there any actual health benefits of a liquid diet?

>> Dr. Gotfried: A lot of people will go on liquid diets, but often focus more on weight loss. But some people think that by going on a liquid diet, they may be cleansing their colon. I think an important thing to know is that your body is detoxifying itself. What I mean by that is that your liver is in charge of clearing toxins out of your body, and your colon is in charge of secreting mucus and flushing things along to make sure that you're going sort of regularly. Pardon the pun, but your colon is there to make sure that things are moving along and keeping the environment sort of clean, so patients will use irrigants, will use enemas, to try to move things along and clear their colon out. I think, generally, when people think about detoxing, they're just trying to get rid of anything that's in their body. So, they'll use any different method that they may find on the Internet. Again, though, I think it fits any of these methods. There's not a lot of scientific data that they are tried and true and beneficial in the way that a lot of people claim they are.

 

>> Joe: So, obviously, as a doctor who sees folks all the time, deals with gastroenterology, I'm sure you have some wild stories about the strange things that your patients have eaten accidentally or maybe and sometimes intentionally. What are some of the oddest things that you've dealt with from things that your patients have swallowed?

 

>> Dr. Gotfried: Yes, so this is the common thing that we do see. And as you alluded to, there are, unfortunately, a lot of people who purposely ingest a lot of things, but we also have people who unintentionally ingest things. And some people come in saying that they unintentionally did, but they intentionally did. Of all the different things I've seen recently, we had a patient who swallowed a toothbrush and, interestingly, a toothbrush was in two pieces. So, there was the head and then the body of the toothbrush. So, unclear exactly why or how that happened, but we were able, with our endoscopes to fish out both the toothbrush head and the toothbrush body. Biggest concern there that the sharp edge of something can cut. I had a patient early on in training who was doing some work outside and he had a good luck medallion that he actually chewed on. And it's something that he wore around his neck. But this time he had it in his mouth for some reason, and that got stuck into the esophagus. So it wasn’t too lucky for him, but luckily we got there and got it out. And then just the garden variety, almost weekly to several times a month basis we’re fishing pens or chicken bones or big pieces of steak that people didn't chew properly. So, tons of stuff to retrieve from the body. Never a shortage, unfortunately. The biggest thing is to make sure that you chew, especially with food and steak and especially around the holidays, to chew your food well and make sure you're not just downing big pieces of turkey on Thanksgiving. That's usually our biggest time to fish things out of people. 

 

>> Joe: I'm sure I've made the mistake once or twice or 5 or 10 times in my life. So, when it comes to parents, say your child accidentally ingests something, do they call you? Should they call 9-1-1? What are the steps there?

>> Dr. Gotfried: Parents should always know, especially with the kids, to be able to call pediatricians. It may be hard to get in touch with doctors throughout the day. And so, 9-1-1 is always, if there's ever a concern, is always the first thing to call. The biggest concern is ingestions. So, that's little toddlers or young kids who are going under the kitchen sink that isn't locked and ingesting bleach or other household cleaning products. That's an emergency that needs to get figured out immediately. Another issue that, I’m an adult gastroenterologists, but that we always talk about and train on is little kids who swallow button batteries. And that's not always a well-known issue, but it could be theoretically life-threatening. The problem is is the button battery conducts electricity between the walls of the esophagus and can literally burn a hole within the esophagus by conducting between the two walls of the esophagus. And so, a button battery is sort of our number one emergency, aside from an ingestion of something that if anyone swallows, they have to come in immediately and kind of drop everything and take care of to make sure that it doesn't cause a problem. Other than that, I actually, my brother-in-law called me a couple of months ago. They were at a Ben and Jerry's factory in Vermont, and my niece lost a tooth eating cookie dough ice cream. And so, they called wondering what they should do. And generally small things like that, like a tooth, goes right through. And so, it's nothing to be concerned about. But he had easy access with me on speed dial, but, always, if you don’t know, it's good to call and make sure that your kid’s okay.

 

>> Joe: Great advice. Great advice. Now, speaking of digestion and moving things along in a body, I know you hear a lot from your patients about constipation. What does that mean? How does it affect me? Is it serious? Is it not serious? You know, what do you consult patients about when it comes to constipation? Does it depend on each person? How does that work?

 

>> Dr. Gotfried: So, constipation is another one where we have to clearly define our terms. Constipation is in the eye of the beholder. So, I've a lot of patients who come in and say, I'm constipated, when they're having a bowel movement every day. I have some people who are going a week or two weeks, and they don't think that they're constipated. And a lot of it's relative. What I tell my patients, it's relative to your usual baseline. So, if you take the normal population, regular bowel movements are one bowel movement every three days or up to three bowel movements in a day. And that's the general population of how frequently people are supposed to go to the bathroom. Now, some people might have more bowel movements than that. And as long as there's no weight loss or blood in the stool or any other alarm symptoms like that, that's not necessarily a concern. And some people may go longer than three days, but if that's their norm, that's not necessarily a bad thing, especially if they're not having pain or discomfort. And so, it's really constipation, there’s a range. But I think the important thing is, is there a change in what you usually do? And has something changed, and why has that changed? And that's the important thing to explore when you're concerned that you may be constipated.

>> Joe: So, essentially, the biggest question isn't the frequency or, you know, how often you're going, but whether it's a change from your normal movements?

 

>> Dr. Gotfried: Exactly, and a thing I love to pull up for my patients is the Bristol Stool Chart. And, so, I have eyeglasses, and so there’s an eye exam chart in every ophthalmologist’s office, and, so, in the GI world, we have the Bristol Stool Chart. And I like to show that to my patients because it kind of helps standardize what bowel movements look like. And so the funny thing, I think a lot of patients kind of laugh at it when you pull up a chart of all these different forms of what stool is. But there are 7 forms of stool, ranging from Type 1, which is like a lumpy, bumpy, almost like a rabbit pellet, to a smooth sausage is like a Type 4, and Type 7 is like a puddle of water like you turn on the faucet. And so that’s in addition to the amount and frequency that people are going, it’s important to also quantify what the stool looks like because that can also tip off if they are constipated or have problems with gut health. So that’s another thing to consider that listeners can view is the Bristol Stool Chart just to kind of see where they think they fall out to guide if think if they’re constipated or have another problem.

 

>> Joe: So, let's switch gears a little bit from something that's coming out of the body to maybe something that's coming in the body. We hear this rumor a lot or this myth a lot about when you eat a piece of gum, you swallow it. It stays in your body for 7, 10 years, something like that. Is that really the case? Are there things that our bodies just can't digest when it comes to food products like gum?

 

>> Dr. Gotfried: That's a great question because it is very relevant. I was just on an airplane and with my kids. We gave them gum as we're taking off to help them from having their ears popping. And we gave gum to my three-and-a-half-year-old for the first time ever, and he dutifully chewed it for three seconds and then swallowed it. And so, he didn't know any better. But my eight-year-old looked to me terrified that he had done something very wrong and that we wouldn't be able to retrieve the gum until my three-year-old was 10. So that's a common myth and something we don't hear so much in the adult GI world. But I think it's out there that things get stuck in your body and gum is one. I think people are concerned that it might stick to something, but I think we have to remember that the GI tract going all the way from the mouth all the way to the other end is a biological system. And it's built to move things from the top down to the bottom. And so, things typically will not get stuck in the stomach or anywhere else along unless it's too big or there's something else with it. So, an uncommon condition is where people eat their hair. It's a psychiatric condition. And so, people can get big things called bezoars in their stomach or beyond. And it serves as a nidus, or an area that can collect more and more stuff. So, people can get these huge kinds of rocks or lumps that get stuck in their stomach for very long periods of time and sometimes have to get removed either endoscopically or surgically in extreme cases. But for regular gums chewers out there, if you accidentally swallow your piece of gum, it's not a big deal, and you should be moving it out in the next couple days.

 

>> Joe: That's a relief. I want to stick with the digestion side of things for a little bit. One thing that we've seen online, a lot of big myths that we hear a lot is about indigestion. Does indigestion happen simply because you eat too fast, you're trying to stuff food in your mouth, and that's as simple as it is? Or is it more complex than that?

 

>> Dr. Gotfried:  So, when we are little, we're always told by our parents not to eat too fast or we’re going to get a stomachache. And there is truth to that. Our stomachs have a certain capacity of how much food that you can intake. And the reflux that will happen is vomiting if you take in too much food. And right before that vomiting might be a signal of what we call dyspepsia, or that's the feeling of discomfort in the stomach, signaling that you may have eaten too much food. Different people can hold different amounts of food. I think the extreme example is going to be people who go to hot dog eating contests or other kinds of food contests in the summer. People like that are eating a ton of food, and they're training their stomachs to be able to expand and accommodate large amounts of food, where if you don't do that and try to eat that much food, your body won't be able to handle it. In the most extreme circumstances, if you eat so much food, the stomach can distend so much that it can actually tear or perforate, which could be a life-threatening situation. So, it's always good to eat at a normal pace and not try to stuff yourself and take it slow because people can get a stomachache by eating too fast.

 

>> Joe: Thanks, Dr. Gotfried. More right after this.

 

>> Joe: Did you know you can you can use merckmanuals.com to find in-depth content about hundreds of medical topics, including those that may be difficult to spell? Simply browse by using the letter spine search function on our website. It’s the best first place to go for easy-to-understand medical content. 

 

>> Joe: Now, before we start eating food around 11 o'clock, 11:30, for some of us, we start to get some stomach growls. It starts to feel uncomfortable in the stomach, and, essentially, we take it as a sign that it's time to eat. Is that really all it is? Is it stomach growling just your body telling you, hey, it's time to start eating some food?

 

>> Dr. Gotfried: That's a great question. Your body is trained to be able to want to eat food and digest food. And it follows sort of a different rhythm throughout the day. And so, when we wake up in the morning, there's already different enzymes and chemical reactions that are going on in our body that occur just by thinking about food. And so, when you're hearing your stomach growl, there's actually a scientific term. If you ever want to sound smart, it's called borborygmi, and borborygmi is a scientific term for a stomach growling. And what's really happening is the folds in your stomach, or the rugae, are moving around and then kind of rubbing against each other. Or the small intestine, also, when you hear sort of those higher pitched sounds, that could be your small intestine that's moving along. And what your body is doing is getting ready or is already ready to ingest food, but you haven't provided food for it. And so, some of those sounds that you'll hear sometimes is because you ate a bunch of food and your body's trying to move food along. But if you haven't eaten, it is that borborygmi. So the take home is listen to your stomach.

 

>> Joe: Are there ever any instances where your stomach growling is a sign to come see you, come see a gastroenterologist?

 

>> Dr. Gotfried: I think you always have to listen to your gut. As a said  in the beginning, if something's outside of your usual routine, it's always good to get it checked out, especially if you don't have a reason why. A growling stomach is not necessarily a bad thing. There are certain conditions where, if there's a blockage in your stomach or in your intestines, there's a very high-pitched stomach noise that you can hear. But that's very rare, and usually you're very sick and vomiting. So, our worlds operate on the extreme in G.I. There are a lot of things that are plain-as-day obvious. And then there's people who don't really have a problem going on. They just have a normal stomach growling. But I think it's important to know that, if something feels very different or outside of the usual routine, it's important to get it checked out.

 

>> Joe: Good to know. Good to know. Another myth we hear or see a lot is about the causes of ulcers. Sometimes we'll hear it’s stress. Sometimes it's alcohol. Sometimes it's spicy food. Sometimes it's smoking. What are the causes of stomach ulcers, and what should people do about it if they feel like they have one?

 

>> Dr. Gotfried: So, ulcers are a very common thing that we see in practice. The manifestations of ulcers are abdominal pain. And in the bigger extremes, people can have life-threatening bleeding or a perforation, or a hole, in the stomach lining from an ulcer. And so, ulcers happen for a variety of reasons. But effectively, it's the body's lack of a barrier and defense and you get sort of an erosion and cratering in the stomach wall or the small intestine wall. That can happen from a variety of reasons. The two most common things that we see are people who use NSAIDs or aspirin. So, NSAIDs being ibuprofen or any of the other pain relief medications that are anti-inflammatory pain relief medications, and, as well, people who have an infection called H. Pylori. That's a bacterial infection that people pick up at various points in their life, really just from the environment. And H. Pylori was shown to be a bacteria that can cause and generate ulcers. And so those are the two common causes of ulcers. But other things that can cause ulcers are smoking and alcohol. Really a lot of alcohol use or a lot of smoking will potentiate more severe ulcers or more severe disease. So you're usually going to see smoking and alcohol on top of someone who's taking a lot of ibuprofen could have a really big ulcer, a very significant bleed from their ulcer disease. A common thing that we see as people saying, I'm stressed out and I have an ulcer. And I think it's important to define what stress is. There's physiological stress, where we have very sick patients who are in intensive care units, let's say, after a car accident or a bad infection. And in that situation, your body is not making the natural defenses it does to be able to prevent yourself from developing ulcers. So those patients can get ulcers from physiologic stress. Stress from the slings and arrows of life has always been associated with ulcer disease. But we don't have any data that it actually causes it. So, there's epidemiologic, or population-based studies, that show, in stressful situations, such as a natural disaster or in people who have behavioral or psychiatric conditions, there may be an increased incidence of ulcers in those populations. But there's no studies, to my knowledge, that show that stress actually causes ulcers.

 

>> Joe: Another stomach condition that we hear about a lot is bloating, and there's a lot of foods that we hear of that can cause bloating or reduce bloating. What foods do you know that can lead to bloating, and what can people do about it?

 

>> Dr. Gotfried: Before going into the different foods that can cause bloating, it’s very important to note that people can have bloating, and it can actually be an alarm symptom and something to be concerned about that needs to get seen. So, for example, people can have blockages or problems moving air or food throughout their colon or intestines because of an obstructing, or a blocking, cancer. So that can happen in ovarian cancer. That can happen in colon cancer, where the stomach and the abdomen can become very distended. And so, bloating is a symptom we see all the time. And it's not concerning and actually having to do with diet. But it could be an alarm symptom and something to be concerned about. So, it is very worthwhile to be evaluated by your physician. All that said, the big qualifier leading into this that you need to investigate bloating, bloating can also be caused just by simple things in the diet that the body cannot ingest appropriately. So, the common thing that we see is people with lactose intolerance. And so that is the inability for the body to digest lactose. And it's a very common thing I see in my patients all the time who, finally, after a couple months, wait to get in to see us, say, I’m having terrible bloating. I say stop drinking three gallons of milk a day, and they come back two weeks later and they feel 100 percent better. So, what that is is your body, as you get older, loses the ability or the enzymes to break down proteins in milk, and that can lead to bloating as well. So, it's a good thing to just try if you have a new bloating symptom that maybe you're drinking too much milk, and it's really specifically milk over milk products. We sometimes tell people to stop cheese and yogurt and other things, but it's really people who are drinking milk. There's a whole other huge group of foods that can cause bloating. And this is where I do encourage patients to research online because there's a lot of good stuff, actually, of different foods that can cause bloating. Common ones that I advise my patients on are garlic and onions. And there's also the cruciferous vegetables. So that's like broccoli and cauliflower, which can cause really bad bloating.

 

>> Joe: And another question we hear a lot, another myth that we see, is this idea that nuts, seeds and popcorn when ingested can cause a diverticular disease. Is that the case?

 

>> Dr. Gotfried: So, this is a very, very, very common question that we get. And I actually had a patient a couple weeks ago who gave me a hug because they loved eating almonds and they had an episode of diverticulitis 20 years before. And they had been told by their doctor at the time, do not eat nuts. It's going to give you another episode of diverticulitis. So, I had seen them a year ago, and I told them that's a myth. It's something that was taught for years. I learned that actually in medical school. But recent data has shown that it's unfounded and actually could help people with diverticular disease. So, a year later, this patient came in and saw me and he had not had an attack of diverticulitis and was eating his almonds daily. And I got a hug for it because I debunked that myth. So, the original idea is eating nuts or popcorn that these foods, because they're hard, could get stuck in diverticula, which are sort of outpouchings, or weak spots, in the colon wall. And then the nuts can plug up those areas, and then they can get infected. What recent data is showing us actually, is that it's the opposite, that essentially popcorn and almonds are higher in fiber, and high-fiber diets are shown to improve diverticular disease and complications from diverticular disease, including bleeding or the infection called diverticulitis.

 

>> Joe: Since we've been kids, a lot of us have been told, before we go in the pool, before we go run in the ocean to swim, we should wait 30 minutes after we eat, before we get in any water body, because it's going to either mess with our bodies or mess with our stomachs. Is that really the case? Is there any real reason to worry or to wait 30 minutes before you go to the water after eating?

 

>> Dr. Gotfried: So, convincing someone to wait to swim for 30 minutes as a tease. Oh, I can't tell you exactly to wait 30 minutes, but it is smart to wait a little bit from the time that you eat and are ingesting food and full time you exercise. So, the scientific reason behind that is that your body uses a huge amount of metabolism, circulation and energy to be able to digest food. It's a big workout for the body, even though you just have to sit there and let your body do its thing. But while you're digesting food, a lot of the blood that would supply your muscles and other organs in your body while you're doing exercise is really getting pulled into the gut to be able to help you digest the food. So, when people have just eaten and they're already running a marathon in their stomach and then you go out and swim, you're putting your body sort of in an overload. And that's where the cramping sensation comes, as the body doesn't have enough blood in circulation to appease all parts of the body. And so that's where the idea of that comes from. So, it's not always going to happen, but it makes sense to exercise first or to swim first and maybe snack a tiny bit and eat your big, huge meal afterwards.

 

>> Joe: So, Dr. Gotfried, thanks for answering all these questions here. I think it was a fantastic conversation. If people who are listening to this have any questions of their own about some gastrointestinal issues or GI tract issues, where can they go online for some information?

 

>> Dr. Gotfried: A great resource to go to is merckmanual.com. It has a ton of well-researched and evidence-based information, and a well-trusted source that patients can find a bunch of answers to many of their questions and hopefully debunk some of the myths out there.

 

>> Joe: And of course, for our listeners outside of the U.S. and Canada, we invite you to visit msdmanuals.com for more information. Well, Dr. Gotfried, thanks again for joining us. And remember, as we say, at the Merck Manuals…

 

>> Dr. Gotfried: …Medical knowledge is power. Pass it on.

 

>> Joe: Thank you.