Flashback Friday: The Best Diet for Upset Stomach

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Dyspepsia is just a fancy word for an upset stomach—feelings of fullness, discomfort, nausea, bloating, belching—affecting up to one in five individuals. In my last video, I talked about the risks associated with proton pump inhibitor drugs like Nexium, as well as folk remedies like baking soda. So, all in all, “studies [have] emphasized the unmet need for medications to treat patients with” dyspepsia—but why not try food?

One study put amalaki to the test, which is just another name for amla. They call it an Ayurvedic drug, but it’s just a fruit—powdered Indian gooseberries.  One teaspoon of dried Indian gooseberry powder three times a day versus an ounce of some gel antacid every three hours. And, both worked just as well: significant decreases in peak acid output, and a cutting of dyspepsia symptom scores in half. They conclude that amla is therefore better, about a hundred times cheaper (about a penny a week instead of a dollar a week), and more convenient than downing antacids six times a day. Though amla may be a safe, simple, natural remedy, such an approach is still very much in the pharmaceutical model of treating the symptoms, rather than the underlying cause. I mean, dyspepsia is not caused by a gooseberry deficiency. What is it caused by?

Well, about one in seven people describing a range of gastrointestinal symptoms feel better cutting out gluten. But for the other 86% of people, the most well-characterized trigger is high-fat meals. If you give people a fatty soup—just broth with added fat—it takes three times longer to empty from your stomach compared to the broth alone, like an hour and a half versus just a half-hour. Now, the emptying rate didn’t necessarily correlate with how people felt. But, regardless, the fatty broth “increased the severity and frequency of” dyspepsia over the regular broth.

What happens in dyspepsia is people become hypersensitive to the stretching of the stomach when you eat. But, it also matters what you eat. The human stomach can normally accommodate about a quart of food; a thousand milliliters; four cups. But, if you stick a balloon into people’s stomachs attached to a hose, people with dyspepsia will start feeling discomfort about here, only at about one-and-a-half cups, when the stomach is less than half-full. But, that’s when you’re dripping fat into their gut. If you’re instead dripping sugar in their gut while you’re blowing up the balloon, it can get up to here before causing discomfort in dyspeptics—about 70% more.

And, the same with fullness and nausea. Increase the pressure in the stomach with fat in there, and fullness and nausea shoot up. With fake fat in your stomach instead, the same pressures resulted in significantly less feelings of fullness and nausea. “These studies have shown that during distension of the stomach”—as the stomach fills up—dietary fats are a major trigger of dyspeptic symptoms such as nausea, pain bloating, and fullness. And, “they modulate…symptoms in a dose related fashion,” meaning more fat, the worse people felt.

These were some pretty elegant experiments, but also a bit artificial. I mean we don’t typically eat with balloons in our stomach. So, how about an experiment using actual food? They compared yogurts high in sugar/low in fat, versus high in fat/low in sugar. Eating the low-fat yogurt, there wasn’t as much difference in the nausea, pain, and bloating scores between those with dyspepsia and healthy subjects. But, give them the same amount of high-fat yogurt, and dyspepsia symptoms shot up almost immediately.

So: “One of our major findings was that the induction of gastrointestinal symptoms after the…test meals was ‘nutrient-specific.’ The consumption of a high-fat test meal was associated with a substantially greater increase in nausea and pain when compared to a high-carbohydrate meal” among those with dyspepsia, “with the [symptoms] scores increasing immediately after” eating.

This would suggest that sufferers not only reduce the amount of food they eat, which is the typical advice, but also try to keep the fat content down—a message echoed by a recent review of all such studies put together. “[C]urrent studies show that fatty foods are associated with occurrence of dyspeptic symptoms, and reduction of fat intake may [help] alleviate symptoms.”

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Image credit: sarangib via Pixabay. Image has been modified.

Motion graphics by Avocado Video.