For a small family, mine has a lot of gastroenterologists. Two years ago, my college-aged firstborn and I both went through a period of such intense stomach problems that we spent months going to specialists, trying different prescription medications, and — in my case — vomiting into trashcans. Fortunately, thanks to serious dietary and lifestyle changes, we both eventually stabilized. Then, a few weeks ago, my younger one was diagnosed with Irritable Bowel Syndrome (IBS). I spent my youth subsisting on cigarettes, pepperoni and beer, and while I can accept that my days of eating like a frat bro are behind me, it's pretty depressing that my kids and their friends carry Tums in their backpacks.
Does your stomach hurt too? It does. Do you watch "Hot Ones" the way a celibate watches porn? You do. Stomach problems are on the rise. The CDC estimates that three million American adults have Crohn's disease and ulcerative colitis — an increase of about one million in the past two decades. And while the sharp spike in celiac diagnoses over the past several years is thanks to greater awareness of the disease and its symptoms — the fact remains that three million Americans have the disease, and roughly 18 million of us have a gluten sensitivity. Thirty million of us are lactose intolerant. Between 10 to 15% of us have IBS, and 20% have gastroesophageal reflux disease (GERD).
Disturbingly, many stomach problems are suddenly manifesting in young people. Gastroparesis, a condition in which the stomach slows down, leading to nausea, pain and vomiting, is escalating among young women. Meanwhile, the National Cancer Institute reports that colorectal cancer has become "a leading cause of cancer death" among Americans under age 50. And the fact that 40% of young adults in America are defined as obese speaks not just to the long term serious health effects, but the day-to-day wear and tear on our collective guts.
So profound is the delicacy of our digestive systems that in recent months we've gone and created an antacid shortage. Of course, the past year has recalibrated our notion of the phrase "stomach-churning." For many, an uptick in stress eating, stress drinking and plain old stress existing on this mortal plane, combined with a downturn in exercising, has led to a lot more Alka Seltzer flying off the shelves.
Dr. Frank Vanzandt Linn, Jr. a gastroenterologist at Middlesex Digestive Health & Endoscopy Center in Massachusetts says that "as pandemic restrictions loosen, we are seeing an increased number of cases of GERD, irritable bowel syndrome and inflammatory bowel disease."
A March report in the Journal of Clinical Gastroenterology unsurprisingly notes, "The COVID-19 pandemic is related to self-reported increases in psychological distress and gastrointestinal symptoms among individuals with IBS and comorbid anxiety and/or depression."
But while the pandemic has exacerbated our agita, our guts were already suffering before everything got so much worse. So what's going on here?
"I think there are several contributing factors," says Dr. Bryan Curtin, Director of The Center for Neurogastroenterology and GI Motility at The Melissa L. Posner Institute for Digestive Health & Liver Disease, "Some of the increased numbers of young patients can be attributed to increased knowledge and diagnosis of various gastrointestinal conditions. Remember that it wasn't that long ago that we thought that ulcers were predominantly caused by stress. Women, especially, were discounted throughout history as having 'hysteria' for conditions that doctors could not adequately explain. We've come a long way since that time, and increased recognition and acceptance of conditions such as IBS has contributed to this increase for sure."
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But he also acknowledges other, very real contributing causes as well. "Diet definitely plays a role," he says. "Our traditional Western diet is filled with processed and unhealthy foods. From an evolutionary perspective, we were never really 'designed' to eat the way we do. Food intolerance to substances like lactose and gluten is widespread, and contributes to these symptoms as well."
Dr. Stefano Guandalini, Professor Emeritus at University of Chicago and founder of its Celiac Disease Center, also notes the environmental factors. "Many GI conditions appear to be much more prevalent in Western societies," he says. And when it comes to specific conditions like inflammatory bowel disease, he notes, "Since the exact causes of IBD are not known, the reasons for the rise are also not known. Most likely, however, they can be found in some of the unhealthy habits found in our societies." He cites "a diet rich in pro-inflammatory foods such as red meats, saturated fats, refined sugars and poor in anti-inflammatory foods (fish, fruits, leafy vegetables, nuts, herbs, beans, whole grain cereals, [and] sedentary lifestyle, favoring – along with diet – obesity. We should note that recent data indicate a special role of visceral adipose tissue and particularly mesenteric adipose tissue, also known as 'creeping fat,' in leading to intestinal inflammation."
It sounds obvious and boring, but we know what we have to do if we don't want to go broke on Pepto Bismol, and we don't want our kids to have a future full of digestive misery. I'm not saying that it is easy. I'm saying that if we want to feel better, we have do what we can to eat a healthier diet with more fiber and fewer foods with the words "flamin'" in their names. To reduce stress. To exercise. And there's one more thing — to not be embarrassed by our gurgling, aching stomachs. Says Dr. Bryan Curtin, "Increased dietary education can be really helpful. De-stigmatize talking about GI-related complaints." But, he adds, "Be sure to talk to your doctor if you have persistent symptoms, so they can be addressed."