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Indigestion 
Diet and lifestyle guidelines

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Indigestion is a feeling of discomfort or pain within the lower chest or abdomen caused by gastric acid irritation within the upper part of the gut namely the oesophagus, stomach or duodenum.  The are many causes of indigestion and abdominal pain but the usual types of indigestion are:-

Heart burn. A burning feeling in the centre of the chest, sometimes combined with an acid taste in the back of the mouth. Usually made worse by eating a large meal, straining or leaning forward. This is caused by acid from the stomach refluxing back into the gullet. If severe the acid can cause marked and chocking coughing.

Classic indigestion comes on shortly after food and is a described as an intermittent burning discomfort in the top of the abdomen. Often helped temporarily by antacid medication (white medicine).   Caused by irritation of the stomach wall (gastritis or an ulcer).  If discomfort starts on an empty stomach (or starts in the middle of the night) it is more likely because of an ulcer or irritation of the section of gut which immediately follows the stomach called the duodenum. 

Indigestion and more often heart burn are common complaints experienced during chemotherapy or after surgery. The cause of pain is stomach acid, the acid that helps to digest your food. Stomach acid increasing normally when you eat, food travels from your mouth down the esophagus through the lower esophageal sphincter. If thereís too much acid, or if the sphincter doesnít work properly, food and stomach acid can flow up or reflux into the oesophagus. Acid reflux irritates the lining of the oesophagus causing ulceration and often causes heartburn. If left long enough this can lead to bleeding or stricture formation (causing food to stick in the throat). The steroids,  or anti-inflammatory drugs often given during chemotherapy can also aggravate indigestion. Bisphonates (bone hardening drugs) can cause indigestion especially if they are taken lying down. 

If indigestion is marked are persistent, especially if associated with pain then further investigation such as an endoscopy is required and treatments with anti-acids or other drugs some dietary and lifestyle measures can help:

Diet and lifestyle suggestions and foods to avoid:

  • Do not overeat and eat slowly
  • Smoking is a common cause of indigestion
  • Avoid strong coffee on an empty stomach
  • Alcohol especially spirits
  • Carbonated drinks (with and without caffeine) 
  • Fried food or foods high in fat
  • Pickled foods
  • Acidic foods such as citrus, onions and tomatoes, if these set off your heartburn.
  • Fruit should not necessarily be avoided unless they trigger your discomfort but eat the whole fruit 
  • Avoid processed juices as these are more acidic
  • Chocolate, cakes, biscuits, muffins
  • Foods that you have discovered trigger your heartburn
  • Small and frequent meals or snacks may be better tolerated
  • Do not eat large meals, especially late at night..
  • Try a tablespoon of crushed linseeds every morning - fantastic for the digestion (contains fibre, antioxidants, healthy fats)

                                    Lifestyle changes which may help "heart burn":

  • Avoid straining if constipated or if lifting keep you mouth open to equalize your abdominal pressure
  • Allow two to three hours to pass after eating before you lie down.
  • Raise the head of your bed (eg with two bricks) so that chest is higher than your feet.
  • Wear looser-fitting clothing.
  • Lose weight, if you are overweight.
  • Wait at least two hours after eating before exercising.
  • When exercising breath out slowly when straining the stomach or lifting.
  • Gentle running is better than weight lifting.
  • If swimming learn to breath well as there is a tendency to hold the breath and strain, particularly with breast stroke.
  • Keep a heartburn journal to track foods or activities that aggravate your symptoms

Other types of abdominal discomfort:

Duodenal ulceration: If discomfort starts on an empty stomach (several hours after food) it is more likely because of an ulcer or irritation of the section of gut which immediately follows the stomach called the duodenum. The steroids which are given with chemotherapy often make this symptom worse or even bring it on in patients who have not previously experienced it. Often medication is prescribed to prevent this symptom.

Small bowel: Interference in the function of the small bowel often leads to colicky pains and blaoting. This means the pain, usually in the centre of the abdomen, starts slowly then build up into a severe spasm then quite quickly resolve only to build up gradually again. This is not usually caused by steroids and may indicate partial obstruction of the small bowel by tumour or fibrous bands caused by previous abdominal surgery. 

Large bowel Problems with the large bowel are often associated with bloating constipation or diarrhoea. 

Constipation: This is mainly constant on the left lower side of the abdomen, if severe there may be some mild colicky type pains.  We are all familiar with the symptoms of constipation which most commonly include an uncomfortable feeling in the back passage, bloating and abdominal cramps. There are many other symptoms which are not so immediately obvious. A recent survey of patients with regular constipation reported the following symptoms:

There are several reasons why constipation may develop.

Ways to prevent constipation:

Dietary tips and constipations:

The main dietary factors that may improve constipation are to drink sufficient fluids (aim for 8 - 10 mugs or glasses per day) and gradually increase the amount of fibre in your diet. Ways to increase dietary fibre include:

Only if these measures fail there are several laxatives are available from the clinic, GP or over the counter. A number of drugs are available for diarrhoea including Codeine and loperamide although a change in diet may help - see diet & diarrhoea

Lower rectum; A feeling of fullness in the back passage, urgency to open bowels and of severe incontinence of wind or faeces. It may be associated with a blood on the stool or a mucous discharge form the back passage. Often caused by radiotherapy to the lower pelvis can be help with suppositories  such as xyloproct. proctocydul or scheriproct - ask your doctor.

Drug therapy

Zantac (ranitidine) decreases the production of acid from the lining of the stomach.  This protects the stomach, oesophagus and duodenum from irritation and ulceration. It works by blocking a receptor in the stomach call the H2 receptor of the gastric parietal cell - so called H2 antagonist. A tablet containing 150mg of ranitidine twice a day (morning and evening). It doesn't matter exactly what times of day you take it but many people try to take it at the same times each day so its easier to remember. If you forget to take your tablet donít panic but  try not to miss more than one or two tablets in a row. Zantac is generally very well tolerated. Side effects are rare but include headache and  skin rashes Very rarely breast tenderness in men may occur.

Zoton (Lansoprazole), Protium (pantoprazole) or Losec (omeprazole) are very successful in treating the symptoms caused by acid irritation. Even if you don't already have indigestion it is useful to give Zoton to prevent these symptoms developing when steroids are given with chemotherapy. It  decreases the production of acid from the lining of the stomach.  This protects the stomach, oesophagus and duodenum from irritation and ulceration. They work by blocking an enzyme (hydrogen-potassium adenosine tri-phosphatase) of the gastric parietal cell - so called proton pump inhibitor. Side effects are rare but include headache, diarrhoea and  skin rashes. Your doctor should be aware if you have problems with your liver and the recommended dose should not be exceeded..

Helpful resources and links

Cancernet-UK: What is cancerAbout specific cancers; Breast | Prostate | Bowel.  About cancer treatments; Chemotherapy | Radiotherapy | Hormones | Biological agents | Complementary.  Lifestyle advice; Exercise | Diet | Smoking | Sunbathing | Alcohol.  Cope with symptomsTraveling | Insurance  | Tests for cancer | Clinical trials. ...site map
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Lifestyle and cancer - the facts. This 2011, edition with a foreword from Paula Radcliffe has been extensively re-written with evidence from the latest research from around the world which demonstrates how diet, exercise and lifestyle changes can; help avoid cancer (read chapter 9 free), cope with treatments side effects; slow the rate of progression of cancer and help prevent  relapse.  This comprehensive essential lifestyle guidebook can be ordered online (£8.95), or downloaded via kindle
Prepared for cancer treatments. Patients and professionals, teamed up with Sue Lawley to produce this 21 minute film which explains chemotherapy & radiotherapy while you watch patients, describing their experiences, side effects and methods to alleviate them. Awarded the NHS communication prize ...  read more / order individually or in bulk for your oncology department 
Keep-healthy.com Practical evidence based advice on healthy living including ways to naturally reduce cholesterol, reduce blood pressure, keep healthy eyesight, hearing, maintain a healthy weight and level of fitness. Includes advice on supplements and other useful products...link
Support groups and self help organisations throughout the UK and internationally. Links to Asian support organisations; Read patient stories, poems and links to the Cancer active website addressing a wide range of complementary issues related to cancer and their a quarterly magazine (ICON)..  submit a link to your group