ZACH MOORE: Welcome to On Health with Houston Methodist. I’m Zach Moore. I’m a photographer and editor here, and I’m also a long-time podcaster.

KATIE MCCALLUM: I’m Katie McCallum. Former researcher, turned health writer, mostly writing for our blogs.

ZACH: And Katie, do you have digestive problems?

KATIE: You’re not supposed to ask that out loud, Zach.

ZACH: Also, how much do you weigh?

KATIE: Oh my God. Okay, I’ll pick the first question over the second. No, I do. I do have digestive problems. It’s not something I have tended to talk about in, kind of, this large audience format before, but I think it’s becoming a topic that people are, sort of, telling each other about more and more these days ‘cause I think a lot of us have digestive problems.

ZACH: Yeah, suddenly you get more comfortable talking about it when you realize other people share that problem.

KATIE: Exactly, yeah.

ZACH: Like, when you think you’re the only one, you’re like, “Eh,” you’re gonna keep that to yourself but.

KATIE: Yeah, you feel like it’s, like, bathroom talk, but then you’re like, “Oh wait, we, kinda, like, are all dealing with the same thing here.” I mean, do you have -- I don’t -- You don’t have digestive problems or do you?

ZACH: I feel like as I’ve gotten older, I’ve noticed certain, you know, things about, you know, “Oh, if I eat too much X, Y, or Z when before I could,” but nothing like, “Oh no, I have to stop this, I have to cut this out, it’s keeping me up all night,” or things like that. You are right about that, the privacy of it all ‘cause even like -- Even going to the bathroom anyway, it’s like, “Hey, I’ll -- Hey, I’ll be right back.” And like where are you going? I know where you’re going. We all know where you’re going.

KATIE: Yeah, no. you don’t need to say, like…

[Laughing]

Probably just, “I’m going to the bathroom. Where else would I be going?” Yeah, I think it’s just more of, like, the chronic piece of it that is, like, what’s concerning. ‘Cause I know when my problems started, they, kinda, came out of nowhere. So, at first I was like, “Oh, this is something, like, scary and weird and, like, oh my gosh.” Like, you hear about people getting diagnosed with colorectal cancer younger and younger and I was like, -- I was, kinda, freaked out. Turns out, everything was fine but it -- Then it switched to, like, “Oh this this a chronic problem for me though. Like, this isn’t just one thing I need to, like, deal with. It’s, like, something I’m gonna have to manage over time.” So, honestly, like, when I’ve had conversations with my friends about this stuff, it’s less about the actual problem and it’s more about, like, we talk more about, like, “Oh, this is what works for me, this is what doesn’t work for me.” Or like, “Oh yeah, when I first started having digestive problems, I was freaked out too. Like, I went to go see a gastroenterologist, you should too.” So, like, I think that part of it is what people are talking about more, which is the less awkward part of it.

ZACH: Right, and you’re absolutely right. We’re talking about chronic digestive problems today, we’re not talking about, like, if you had a -- You know, a bad hamburger or bad salad and then, you’re like, you know, upset stomach for a couple days and food poisoning. Trust me, nobody wants it, it’s terrible. But fortunately, that lasts a couple days…

KATIE: Yeah.

ZACH: Hopefully. And then you’re on the other end of it. But we’re talking about chronic digestive problems today, and who did we talk to, Katie?

KATIE: We talked to Dr. Eamonn Quigley, he’s a gastroenterologist here at Houston Methodist and we pretty much talk all things digestive problems all the way from if it’s just maybe some diet modifications you need to make and how to know if it’s just diet modifications and when it might be something more. And then even into, like, the, kinda, more serious symptoms that you definitely should not confuse with just, like, a chronic digestive problem that needs to be managed.

ZACH: Mhm. Well, let’s get into it.

[Sound effect signaling beginning of interview]

KATIE: I’m here with Dr. Eamonn Quigley, gastroenterologist here at Houston Methodist. Hi Dr. Quigley.

DR. EAMONN QUIGLEY: Hi there, how are you today?

KATIE: I’m good, I’m good. How are you?

DR. QUIGLEY: Not too bad.

KATIE: Good, good. So, we’re here to talk about digestive problems, gut health, and everything in between. I increasingly have been, sorta, hearing from more of my friends that, you know, we’re all,  kinda, collecting some stomach problems, digestive problems, heartburn. I, myself, kinda, have some of my own. They started in my late 20s and it’s felt like they came out of nowhere and, you know, I’ve been dealing with them for a while now. And I wanted to get your take on if you’ve also seen this trend of whereas more of your patient population becoming people with specifically digestive problems and things like that?

DR. QUIGLEY: There’s no doubt that gastrointestinal problems have become more common for us, in the sense that more and more patients are being referred to us. In fact, I recently saw some data from Greater Houston that the number one referral to a specialist in our primary care group is for GI problems.

KATIE: Wow.

DR. QUIGLEY: It’s more than anything else. Now, is that because people are suffering more, or is it because they’re more aware of them, or they feel they may be more distressed by them, or they may be more worried about them. I don’t know. I think it may be some combination of all of those things.

KATIE: Gotcha. Yeah, that makes sense. I will say, it seems like we’re suffering less in silence about, you know, digestive problems. I think “The bathroom talk,” like, we’ve not talked about it for a long time, but it seems a bit more, like, it’s okay now to talk.

DR. QUIGLEY: So, a lot of that is very appropriate because, you know, we all are trying to pick up disease at an earlier stage ‘cause the earlier you pick up disease, the more likely you are to be able to treat or even cure it. So, a lot of that is very appropriate.

KATIE: Yeah. So, kinda, diving into what digestive problems really means, I think, kind of, getting into what that is. So, what are the most common digestive problems that you see in your clinic, like, right now?

DR. QUIGLEY: So, let’s start at the top and work downwards…

[Chuckling]

Anatomically. So, starting at the top, gastroesophageal reflux which, in lay terms, means heartburn and acid reflux is very common.

KATIE: Okay.

DR. QUIGLEY: Then the next thing you come on to are more gastric problems like ulcers, indigestion, inability to finish a meal, unexplained nausea and vomiting. Then moving on to the small intestine, you get things like Celiac disease and difficulties with tolerance to certain foods have become a big issue. And then moving further down, you talk about constipation, unexplained diarrhea, and then into things like inflammatory bowel disease, Crohn’s disease, colitis, etc.  But of course, gastroenterologists also look out for liver disease, pancreatic disease, and disease of the gall bladder and bile ducts where you would have things like hepatitis, fatty liver.  Big issue. And nowadays, gall stones and pancreatitis also become problems.

KATIE: Yeah, it’s quite a long list.

DR. QUIGLEY: Yes.

KATIE: So, there’s -- There’s enough -- There’s enough to, maybe, potentially, sort of, think you might, you know, have problems with and things like that. One thing I’ve noticed is that even when I’m talking to my friends, they’re like, “Oh, you know, I’m getting heartburn more than usual, I’m gonna go grab some Tums,” or “I’m gonna go peruse the over the counter, kind of, like, digestive aisle and just see what I can find.” And trying to treat this stuff at home and often not having much success, do you find people are waiting too long to come see you about a digestive problem? Or is it the right amount of time and it is just a time issue. Like, you have to wait for a while if symptoms persist.

DR. QUIGLEY: I think it’s all over the place.

KATIE: Okay.

DR. QUIGLEY: I think for some people, they get anxious the very minute they get some digestive problem. For most, they’ll say “It’s not too bad, I’ll manage it, I’ll do this.” Just as you described and they may come too late. So, it’s a mixture of things. Unfortunately, there are other factors which come into play here, for example, like health insurance and access to healthcare. For some people, unfortunately, who have difficulty with access to healthcare, which could be for various reasons, they can’t take time off work, they can’t afford to take time off work, they may postpone things a little bit too long, unfortunately.

KATIE: Yeah. For people who are, kinda, delaying coming in to see you, what are some of the biggest signs that you would say? I know we rattled off a lot of different digestive problems but are there any, kind of, digestive symptoms as a whole that you would say, like, once you’re experiencing these, that’s when it’s time to come in, it’s time to do something about it?

DR. QUIGLEY: Obviously, the presence of blood in any form, whether you vomit blood or pass blood or pass dark stools, that’s obviously a big red flag. Weight loss, another very important red flag, persistent nausea, vomiting, persistent pain, any of these symptoms that persist beyond being dealt with by a simple, over the counter remedy or something you pick up at the pharmacy or the health food store or whatever, anything that persists like that I’d certainly be worried about and certainly bleeding, persistent pain, persistent vomiting, weight loss, loss of appetite. These are very important red flags.

KATIE: Gotcha. One symptom I wanna ask you about ‘cause I think it’s the one that I’ve had the most grey area on is bloating and, like, abdominal bloating. I mean, when is that, just, “I ate too much,” when is it, you know, like, oh, “I’m just gassy because of what I ate?” Like, is that ever a sign that, like, something’s going on, that someone should seek help for?

DR. QUIGLEY: Bloating is a very difficult issue.

KATIE: Okay.

DR. QUIGLEY: Bloating is the sensation of being distended. Distension is actually being visibly distended. You may say that’s a bit of splitting hairs, but actually to us, it is important ‘cause if you -- If you are actually physically distended, then we gotta think of, you know, what could be causing that distention. It could just be air, but it could also be fluid, which shouldn’t be accumulating in your tummy, or it could be a mass or a tumor. So, I think bloating is a very, very common symptom in the community. For most people, it’s transient, it occurs every now and then or, just as you described, when they eat too much or eat the wrong things. For others, it can be a very disabling symptom and one that we don’t fully understand, I have to admit.

KATIE: Okay. When you mentioned the kind of sensation or perception of feeling full or feeling distended, is that -- Does that get into this kind of nerve, you know, how your gut, kinda, has a mind of its own? I once read a book called “The Second Brain” where, like, I learned that the gut can, kinda, like, actually operate on it’s own away from the brain for some period of time, which I found crazy.

DR. QUIGLEY: What you’re getting into is what is -- What has become a really essential issue for a lot of these disorders, namely the issue of the gut-brain access.

KATIE: Okay.

DR. QUIGLEY: You don’t need to be a genius or an M.D. or anybody to understand that your brain can rule your guts. All you gotta do is go for a test, if you’re in any stressful situation and you got some diarrhea and you got some tummy upset then you know the brain is definitely linked to the gut. And the gut can influence the brain. But you’re right. There are a lot of activities that go on in the gut that can go on independently, but there is an intricate relationship between the brain and the gut which becomes very important for some people. The good news is that I think people are beginning to understand that and when you talk about this brain-gut connection, they say, “Oh yeah, I know what you’re talking about. You know, I was stressed last week, you know, I was late for work,” whatever it is. And they understand that. But that is a lot more -- it can have a lot more long-term effects. For example, we now understand that stress during childhood can have effects that last for many, many years and can prominently feature chronic gastrointestinal symptoms. And even when you take diseases that you say, “Well, we know the causes,” I’d say, like, inflammatory bowel diseases like colitis. Yes, we know it’s caused by inflammation, yes we know the bleeding is caused by inflammation, but if you’re stressed as well, that can have an additional effect on your symptoms, and it can in fact compromise your treatment. So, stress, anxiety, depression, panic attacks, etcetera, they’re all very important in terms of the interpretation of gastrointestinal symptoms and play a major part in the development of symptoms, and the severity of symptoms, and the response to treatment, and that’s why, say here at Houston Methodist and elsewhere, we’re trying to introduce a multi-dimensional approach in managing the patients with gastrointestinal problems including a dietitian and now, in the process of hiring a psychologist who’ll be here with us working day by day with us to manage these patients.

KATIE: Yeah, that’s really interesting. You brought up another piece of this that I was gonna ask you about, the dietitian and the -- Diet, the role of diet. I know I -- We’ve all heard people saying -- I know these are real things, lactose intolerance, and Celiac disease, and being gluten sensitive, and things like that. Do you think though, are they sometimes, sort of, overblown? Do people, kind of, think they have they have ‘em when they don’t? And then how much -- I know this is a very loaded question, but when do you know it’s a diet problem that’s causing your gut issues?

DR. QUIGLEY: Essentially, I gave -- I actually gave a talk yesterday about this very subject so maybe I can remember some of it.

[Laughing]

So, let’s take it from the patient’s perspective.

KATIE: Mhm.

DR. QUIGLEY: So, the patient comes into my office, and they say, “I think I’ve got a food allergy.” I can tell them most of the time that they probably don’t. Food allergy is a very specific issue where you develop an immune reaction to a food or a component of food.

KATIE: Mhm.

DR. QUIGLEY: And it actually doesn’t cause much in the way of GI symptoms, it mostly causes typical allergy symptoms like swelling of the lips, tingling in the mouth, even maybe difficulty breathing, and in fact, in severe cases, it can lead to anaphylaxis and death.

KATIE: Mhm.

DR. QUIGLEY: So, that’s food allergy and that’s -- Food allergy certainly occurs, it’s more common in children than in adults, but as an explanation of chronic GI symptoms in adults, it’s actually pretty rare.

KATIE: Okay.

DR. QUIGLEY: What is much more common and what you’re alluding to is what we refer to as food intolerance. Now, what’s the difference? A food allergy is an immunological reaction as I just mentioned, and you can detect antibodies and make the diagnosis. A food intolerance is where you may not have an adequate enzyme armamentarium to be able to cope with certain foods. You may not have enough lactase to deal with milk, you may not have enough sucrase to deal with sucrose etcetera. We have these enzymes, which break down these molecules, but we may not have enough of them if we’re overwhelmed or if sometimes, genetically determined, we actually are deficient in those enzymes. That’s not an immune reaction, that’s a chemical response. You just haven’t enough enzyme to break it down so that you can absorb it. Instead, it ends up going to the colon where the bacteria do have the enzymes to break it down, they break it down, they produce gas, they produce other molecules that cause diarrhea, and that’s how you get food intolerance. So, they’re quite different things. And the Celiac issue is a very interesting one as well because Celiac disease affects about 1% of the population and that’s due to an immunologic response to gluten in wheat. It’s not quite the same as a food allergy in the sense, with the food allergy, you get an immediate reaction, and Celiac disease takes much longer to develop, it’s much more complex immune response. But a lot of people feel they’re intolerant to gluten and we now know that that’s probably more complicated.

KATIE: Okay.

DR. QUIGLEY: And let me tell you what I mean by that. So, when you eat wheat, you’re not just getting gluten, but you’re getting a lot of other stuff as well. And one of the stuffs that you’re getting is a compound called Fructans. And Fructans are among those molecules, those carbohydrates that we can struggle to digest. So, in a lot of cases, if you’re intolerant to wheat, it’s actually not gluten, it’s probably Fructans.

KATIE: Okay.

DR. QUIGLEY: Are causing the problem. And there are a number of other potential issues with wheat which might cause problems for you. The other thing you must remember with all of these food intolerances or allergies as people think they have is that one of the most important stimuli to every function in the gut is to eat. So, no matter what you have, whether it’s your gall bladder is inflamed, your colon is inflamed, whatever it is, when you eat, you’re gonna feel worse, and that’s not -- Doesn’t mean to say the food has got anything wrong with it, it’s just -- it’s normal for your body at the motility, the secretion, the blood flow, everything in your GI tract responds to when you eat because that’s what it’s supposed to do.

KATIE: Right.

DR. QUIGLEY: ‘Cause the reason you have a GI tract is so that you can digest food and absorb food and take on board the nutrients that you need on a daily basis.

KATIE: Gotcha. I guess, my next question is, it’s all pretty complex, is it our diet that’s -- You know, when we’re talking about how perhaps there’s more digestive problems just floating about these days, maybe people are reporting it more, maybe there are just more. Has our diet shifted at all in a way that’s bad? I know you mentioned Fructans and things like that. How would I find those on a label, I guess, is what I mean, or what am I looking for?

DR. QUIGLEY: Just as a general comment, there’s no question our diet is worse.

KATIE: Okay. That sounds about right.

DR. QUIGLEY: Yeah, so -- And there’s lots and lots of data now to show that as we’ve drifted away from, you know, the non-processed, kind of, vegetables from the farm, fruit from the tree, that type of diet towards highly processed foods, we’re definitely not helping ourselves. And one of the reasons there’s a lot of reflux is because people are overweight ‘cause one of the major causes of reflux is being overweight. The reason we have an epidemic of fatty liver disease is because people are overweight. And certainly, an excessive intake of highly refined sugars is a major problem in that regard. So, that’s a very important cause of more GI symptoms for sure.

[Music plays to signal a pause in the episode]

 ZACH: Maybe you’ve heard that fiber is important for good gut health or maybe you haven’t. In either case, most adults don’t get enough of it. Only about 5% of men and 9% of women meet the daily fiber recommendation set by the National Academy of Medicine. This is a shame since it plays some really important roles in our body helping foster a diverse and happy gut microbiome, the bacteria living in your colon that contribute to digestion, immune function, and more. Fiber also helps keep your bowel movements regular, something you might not consider until things go wrong. Regular intake can also benefit cholesterol, blood sugar, and blood pressure levels and, as a critical part of a balanced diet, help you feel fuller for longer between meals. Men should aim to get about 38 grams of fiber per day, and women should aim for about 25 grams. And one more note, it’s best to try and get all of the fiber you need from the foods that make up your daily diet.

[Music plays to signal resumption of episode]

KATIE: Where should someone begin if they think they have a food intolerance or that their GI symptoms are related to that? Is that just eat a healthier diet or is that come see you and there’s some test we can take to figure out what you should or shouldn’t eat? You know, what’s -- That way you could, kinda, just keep your diet and take out the bad stuff, like, is that too hopeful?

DR. QUIGLEY: This is a very important question. I can tell you one thing they should not do…

KATIE: Okay.

DR. QUIGLEY: Is go and get food allergy testing that they mail in, or they send it in somewhere or another, you’re wasting your money.

KATIE: Okay.

DR. QUIGLEY: Similarly, they should do microbiome testing unless it’s done as part of the research study…

KATIE: Okay.

DR. QUIGLEY: It is not worth their while. So, what they should do is if they think that there’s a particular food that’s the problem, keep a food diary. You just follow what you’re doing over a week, and then maybe you can pinpoint, “Well,” you know, “That’s when I got bloated, I was okay this day.” And then see if you can match up the symptoms with a particular food. That’s a very good place to start.

KATIE: Okay.

DR. QUIGLEY: ‘Cause what are the intolerances that we really think about? The common ones are milk, milk products, lactose intolerance, sucrose, isomaltose, which is sucrose,  which is common sugar, sorbitol, which is very common, and that’s of course what you find in these sugar substitutes, and a lot of -- They use a lot as a sweetener -- As an artificial sweetener, lots of things. So, there are things like that you can pick out. You may not need any test to actually pick those out and we can eliminate them and then you can do a simple trial yourself. Again, cut those out, feel great, then I reintroduced it, trouble again, then you don’t need me to tell you that. But difficulty with eating can reflect anything going on in the GI tract because when you eat, it stirs up everything, and if you got anything going on in your GI tract, you’re probably gonna feel worse. So, if you’re -- Continue to have difficulty with eating, you know, it’s leading to vomiting and loss of appetite and weight loss, you should definitely see a doctor.

KATIE: In that mean time before you see a doctor, I wanted to move into some of the over-the-counter remedies and supplements and things that are out there for people to try and get your take on which ones are worth it, not worth it. I’m glad you brought up the gut microbiome testing and the food allergy testing, so those -- Already got the nix, those are a no-go in your book?

DR. QUIGLEY: Correct.

KATIE: What about digestive supplements? Whether, you know, you’re walking the aisle and it says -- Not necessarily probiotics, but they say, we can get to those. They just say, like, digestive aid or digestive supplements of some kind. Is there anything really you can take to supplement in a good way, like, get better gut health in that way?

DR. QUIGLEY: Well, I think eating a good diet is probably more important than taking any of those supplements, and it’s quite simple whether you’re looking at this from the point of your GI health or heart health or any other health. The Mediterranean diet is a very good place to start. Now, I know it gets more expensive as you’re talking about, you know, fresh fruit and vegetables, you’re talking about more olive oil, you’re talking about more you know, fish, etc., but if you look at all the literature for all these conditions, the Mediterranean diet, or some version of it, wins out all the time.

KATIE: It’s funny, we -- Almost every podcast episode we’ve done on some sort of issue, the Mediterranean diet is the one that comes, like, back and back and back. So, yeah, it’s --

DR. QUIGLEY: And there’s lots of data now to support it. Variety of things. Now, there are variants of the Mediterranean diet and, you know, I’m not qualified to speak on how one compares to the other, but as seen, as a general theme, the Mediterranean diet wins out. So, that’s one thing.

KATIE: Okay.

DR. QUIGLEY: Now, in terms of supplements, I don’t see the logic behind using digestive enzymes…

KATIE: Mhm.

DR. QUIGLEY: Unless you’re enzyme deficient, and then we have very specific treatments, for example, people who’ve got severe pancreatic disease become deficient in pancreatic enzymes and there’s a specific supplement with the correct dose, which is calculated for them. You won’t get that over the counter.

KATIE: Okay.

DR. QUIGLEY: So, the things over the counter for the most part, I probably -- I think they’re probably ineffective and I don’t see how they would help you.

KATIE: Do you mean even, like, the dairy relief ones?

DR. QUIGLEY: Well then that’s completely different, that’s a very specific aid. So, if you’re talking about lactade or sucrade there, that’s for a specific deficiency. That’s completely different so that’s highly appropriate.

KATIE: Okay.

DR. QUIGLEY: But what I’m talking about it says you got these preparations that say, “We give you digestive enzymes.” That’s what I’m talking about.

KATIE: This universal, kind of, like, we don’t know what’s -- Okay, gotcha, gotcha. Okay, so the next thing I wanna talk about that’s in the over-the-counter supplement area is probiotics and probably worth, like, a whole podcast episode I would imagine. What’s your take on probiotics? Whether a person has IBS or something else, like? Do probiotics really help I think is my question. I feel like I’ve heard a lot of different explanations and curious to get your take.

DR. QUIGLEY: I must admit to a certain bias here ‘cause I’ve studied probiotics for many years.

KATIE: Well, this is perfect then, you know?

DR. QUIGLEY: I have a real interest in them, so. But you are correct, there’s an enormous amount of nonsense out there about probiotics.

KATIE: Okay.

DR. QUIGLEY: There’s also a lot of good science. The problem with probiotics is that they’re not regulated in the same way that drugs are. They don’t have to meet the same standards for approval. All they gotta do is show that they’re safe, which they are, usually. Quality control is not the same as for drugs. The rate at which they’re being tested in and conditions aren’t the same as drugs. So, unfortunately, the consumer is left with a lot of claims but not much evidence which, of course, they can’t necessarily find very easily.

KATIE: Yeah.

DR. QUIGLEY: So, what I would say is that a probiotic, which has been correctly formulated, and by that I mean that the -- It’s known precisely what’s in the formulation. That means that you know the genome of the probiotic and you can guarantee that in this product, all we’ve got is this bacteria and nothing else. And also that you’ve shown that for whatever the shelf life is proposed for that probiotic that that bacteria will still be alive at the end of it. ‘Cause by definition, a probiotic should be live bacteria. Once you got over those quality assurance issues, you’ve eliminated an awful lot of what’s out there.

KATIE: Mhm.

DR. QUIGLEY: Then the next thing is can they actually do any good? And the answer is yes, there are certain probiotics which can help patients with bloating, irritable bowel syndrome, and a number of other conditions, so -- But they’re relatively few in number and they have been subjected to rigorous clinical trials, they’re being subjected to metanalysis, systematic reviews, and it comes out showing that some probiotics do actually benefit people with irritable bowel syndrome or irritable bowel type complaints.

KATIE: Gotcha. What about prebiotics?

DR. QUIGLEY: Very important question. So, a prebiotic is of course not a bacteria. A prebiotic is a substitution carbohydrates, which when ingested, stimulates the growth of quote, unquote “Good bacteria.” Prebiotics also have quite a bit of science and I think they’re a very interesting group of compounds because they are a dietary supplement so they are pretty well safe and free from complications and they are now being developed in a very specific way. Notice that they’re tailoring the prebiotic development to promote a certain nu -- A certain group of bacteria which are known to have certain beneficial effects so. You know, a lot of fibers are prebiotics for example. So, not all fibers are prebiotics, but a lot of fibers are prebiotics, but a lot of fibers are prebiotics ‘cause that’s how they act, they act to promote bacteria. The colon act in that way.

KATIE: Okay, interesting. I didn’t know that. Along that vein, you know, let’s say someone’s struggling with a particular digestive problem, X symptom, they’ve tried some of these things we’ve just talked about, it’s not really working, maybe they’ve also tried some -- you know whatever the over-the-counter, whether it’s Gas-X or a laxative or an antidiarrheal. I guess the question really is, you know, to sort of, like, wrap all this together of what you would recommend, how long do you want someone to try, for instance, taking Gas-X or taking a laxative before they come see you? I know you’ve talked about the symptoms, but, like, how long should you rely on some of these over-the-counter options?

DR. QUIGLEY: As a general rule, if it’s been going on for four to six weeks or longer, you should be thinking about seeing a doctor. Now, it also depends on how quickly things develop. So, if you suddenly develop pain, that’s a lot more significant than if you gradually became a little bit uncomfortable and it progressed, that may be less significant. So, if you develop the symptoms suddenly, then that’s something you should really take care of. Now, in terms of duration, I would say if you’ve been constipated and you tried an over-the-counter laxative and it hasn’t worked, and you’ve tried it for a few weeks, then at that stage, you should see a doctor. The same will go for heartburn. If you’ve had heartburn for a long time and if it’s not getting better with over-the-counter stuff, and if you’re having it frequently, if you’re having heartburn more than once a week, certainly I would begin  to think about seeing a doctor.

KATIE: Gotcha, gotcha. One final question too to wrap this up. I know we’ve been talking about the digestive problems, are there any symptoms that are, kind of, the more serious digestive symptoms too that you would add to the list of, you know, blood in the stool. Is there anything else like that that you’d say definitely come in, don’t wait, and sort of, the complications of waiting and things like that?

DR. QUIGLEY: Yeah, difficulty swallowing.

KATIE: Okay.

DR. QUIGLEY: Difficulty -- certainly -- If you got difficulty swallowing, I would definitely get seen -- That seen to as soon as possible.

KATIE: Okay. Well, is there anything else you think that would be helpful for our listeners to know if they’re struggling with a digestive problem or know someone that is? Anything you’d wanna leave the audience with?

DR. QUIGLEY: I think the things I said earlier, namely listening to your symptoms, trying to get a feel for how frequent they are, how much they’re incapacitating you, are they progressing, are they intermittent? Keeping a food diary. Can you see relationships between your symptoms of certain foods? All of those things are very important. And then, you know, as I said earlier, if there’s any signs of bleeding, if you’re losing weight, if you’re having difficulty swallowing, if you’re having persistent pain or vomiting, those are all things you should be seen for.

KATIE: Alright, this has been great. Thanks so much for coming on today with us, Dr. Quigley, really, really appreciate it.

DR. QUIGLEY: My pleasure, thank you.

[Sound effect signaling end of interview]

ZACH: So, something stuck out to me there, Katie, was Dr. Quigley said “You know what? These food allergy tests? Don’t bother with them.”

KATIE: Yeah. It wasn’t surprising to me, but I have to say, I have done one ‘cause I just couldn't help myself…

ZACH: Okay.

KATIE: And like, when you’re having problems, you just, like, want answers even though, like, I kinda knew better, but there was a sale. But one thing I’ll say that I don’t think people realize until you, like, get the kit and you do it, it requires a lot of, like, your blood. So, you have to prick your finger and fill out this, like, filter paper with your blood, like drops of your blood. I had to prick my finger, like, four or five times. Like, my whole hand pretty much got pricked just to get enough blood on this little filter paper thing for them. So, like, it was a lot of blood, a lot of work. So, that part, they gloss over.

[Chucking]

The instructions when you’re purchasing it. And to be perfectly honest, I didn’t really learn much, so.

ZACH: Okay, interesting. But you know something he did recommend was food journaling.

KATIE: Mhm.

ZACH: Which can sound intimidating I think sometimes to people.

KATIE: No, it can but I think when you’re that desperate and you have a problem that you just cannot find the answer to, like, you’re way more motivated to, like, put in the work and actually write everything down and write down your accompanying symptoms and stuff like that. It is a lot of work but I know people that it’s worked for. For me, I’ve never really been able to figure out a food trigger. I think mine’s just, like, kinda comp -- Like, a lot of different things coming together, but it did help me, like, learn that I was probably not eating enough fiber. Now, eating enough didn’t really solve everything for me but, like, then I could check that off as like, “Okay, that’s not the ultimate problem, let’s move on to the next thing.” So, like, yeah, no, it’s an important part of it.

ZACH: Yeah, and we all know -- I mean, we can -- Even if you’re not writing it down, we all know, like, “Oh, if I eat too much cheese” or whatever, right? You can feel certain things. So, even intuitively, you can figure it out but absolutely, like, putting it down where you can reference it later…

KATIE: Yeah.

ZACH: Is highly recommended. Now, you talking about figuring all this stuff out, another great thing he said, the difference between food allergies and food intolerance.

KATIE: Yeah, I think a lot of people confuse them or talk about them in the same way. It was interesting, I actually didn’t know -- I mean, I guess I maybe knew. A food allergy isn’t really even digestive symptoms, it’s still the regular, like, anaphylactic allergy symptoms. So, people calling them -- Giving themselves a food allergy, like. Uless your throat is swelling up or something, like, it’s probably not a food allergy. But yeah, a lot of us just have intolerances or sensitivities, and that’s, kinda, what I did with that testing, was they tell you what you’re intolerant -- Well, they quote, unquote “tell you what you’re intolerant to.” I know I’m sensitive to lactose so that’s confirmed but that’s about it for me. Do you know that -- Do you know if you’re, like, sensitive or intolerant to anything?

ZACH: No, I’ve never had an official, you know, food allergy test or anything like that, and then I wasn’t going to after…

KATIE: Well, now you shouldn’t, so yeah.

ZACH: After talking to Dr. Quigley. So, I do -- I have -- Like I said when we started talking earlier, I have noticed certain things when I, like, eat too much of X, Y, or Z, and maybe I really should start documenting those things to have it actual tangible, like, “Oh, you know what? I should eat less tomato sauce.” Or something. Like, well, yeah.

KATIE: Nightshades. Tom Brady doesn’t like tomatoes either, so.

ZACH: And I love, like cheese and tomatoes and all those stu -- All the things you love.

KATIE: Cheese is bad for me. Cheese is the unfortunate one that, like, I know is not good for me but it’s, like, really hard to avoid. I actually do avoid it a lot, but then every now and then I’m like -- It has to be a really good reason for me to have cheese and I’ll do it. Like if I’m just in the mood for some queso, like, I know it’s gonna be bad, but it’s worth it every now and then for me. And -- But another thing, going back to the testing and all this, sort of, like, gut testing that you can do, microbiome testing is another popular one. It’s becoming more popular. I think the first one I kept seeing was the food sensitivity testing. Now, the microbiome testing is more and more popular, and he also, kinda, said that’s a waste of money too. So, you know, good to know because it’s also expensive and --

ZACH: No, but -- No, this is good to know, because if you’re -- If you’re a novice like me as established on this podcast, you’re like, “How should I get to the bottom of my food? Oh, I’m gonna do a food allergy test.” And then you’re x-amount of money in this or that and if something’s not gonna work, then you’re gonna try the other thing and then it -- Yeah. Go to your primary care physician, they give you an insight, then they can refer you to a specialist, they give you even further insight.

KATIE: Yeah, exactly. I think, you know, people do microbiome testing, like, in clinical trials and in studies but that’s really controlled, but these at home kits that you get are just, like -- They’re just not -- I think the point is no one knows what a quote unquote “Normal microbiome” is. So, it’s like, how do you know if yours is wrong? And even if it is, what are you doing with that information too? So, there’s a lot of, like, question marks with that one that he brought up that I thought were interesting.

ZACH: And the at-homeness intimidates me. I’m like, “Did I do something wrong? Like, am I gonna -- Do I need to do it again? Did I leave it soaking in the whatever long enough of however -- You know” -- Those things have a different procedure. So, again, go to a specialist, they can walk you through ‘cause everybody’s body is different, everybody’s gonna have different reactions to different things, and they can read that information as you said, and give you an informed opinion than you getting all this information saying, “Well, what do I -- What do I do with it?”

KATIE: Agreed. I think that’s a really good point and I think that was, kinda, like, the take home message of this -- Digestive problems are complex and, like, there’s some places to start for sure and there’s some places you shouldn’t start like we walked about, but at the end of the day, like, if it’s become chronic like it’s time to go see a doctor so you can get to the bottom of what it is. Maybe it’s lifestyle changes for you, maybe it’s a little bit more and you need to manage it in certain ways. But yeah, I think -- I think he gave us a lot of really good insight to, like, what to do when you don’t know what to do about your gut issues.

ZACH: What to do when you don’t know what to do.

KATIE: Mhm.

ZACH: Well, that’s gonna do it for this episode of On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings.  So, until then, stay tuned and stay healthy.

[Music ends signaling end of episode]