Gut wrenching

There’s nothing wrong with being polite. Saying “please” and “thank you,” using the turning signal, holding the door for a stranger—these are all good things. There’s such a thing, though, as being too polite, especially where our health’s concerned. Even in the doctor’s office, many Canadians are reluctant to talk about their “gas, diarrhea or bloating,” says Dr. Richard Fedorak, president of the Canadian Digestive Health Foundation. “You don’t go out for dinner and discuss that with your guests. It’s fine to discuss your high blood pressure or your diabetes, but you don’t discuss your gas.”

We might hesitate before airing our stomach problems in public, but they’re more common—and sometimes more serious—than most people think. Earlier this year, Scienta Health, a medical clinic in Toronto that specializes in preventative care, provided Maclean’s readers with its Q-GAP test, an online quiz developed by Scienta with 75 questions on topics ranging from sleep patterns to sex drive, to help people note symptoms that could point to underlying health problems. (The Q-GAP test is now available again at macleans.ca/howhealthy.) Over 14,000 people completed the test anonymously. Of all the symptoms identified, indigestion, heartburn, acid reflux, bloating and passing gas were among the most prevalent (of nine categories used in the test, gastrointestinal symptoms were second only to emotional health concerns among both men and women).

People tend to assume these problems are just part of the aging process, or maybe the result of last night’s spicy meal. But that’s a mistake, says Dr. Elaine Chin, co-founder and chief medical officer at Scienta Health. “Your gastric system is your input. It’s the first line of bringing nutrients into your body,” which is critical to the immune system, she says. “When the conveyor belt is screwed up, that’s where other problems start.” It’s not just a quality of life issue. An upset stomach can be a red flag for anything from poor diet to a heart attack. “We just ignore it, because we think we can’t do anything about it,” Chin says. That approach could be doing more harm than good.

In fact, “Canada has some high incidences of digestive diseases,” says Fedorak, director of the gastroenterology division at the University of Alberta. According to him, we have one of the highest rates of celiac disease in the world: an estimated one in 133 Canadians suffer from this condition, a gluten intolerance that damages the intestine. Another 200,000 have inflammatory bowel disease (Crohn’s disease and ulcerative colitis). Six million Canadians have gastroesophageal reflux disease (GERD), when stomach contents splash up into the esophagus. Of the top 20 prescription medications dispensed in Canada last year, four were proton pump inhibitors (which suppress stomach acid), according to IMS Health Canada, a health and market information company.

What’s more, gastrointestinal ailments are among the top three reasons Canadians visit the doctor, and cause about 191,000 deaths a year (including colon cancer deaths), notes Kris Chadee, chair of the gastrointestinal research group at the University of Calgary. The Canadian health care system spends roughly $8 billion a year on digestive disease, Fedorak adds.

But these problems may be even more common than numbers suggest, as countless sufferers don’t make it to the doctor’s office. In one McMaster University study, over one-quarter of Canadians reported suffering from digestive symptoms within the past three months. “The average time from onset to diagnosis of Crohn’s disease is 3½ years. That’s way too long,” Fedorak says. “We need to educate people that pain, cramps and diarrhea lasting for years is not normal.”

The digestive system doesn’t just process food. It has an important role to play in our entire health, Chin says. And it’s an amazing piece of equipment. In a normal adult male, the gastrointestinal tract—which spans from the mouth to the anus—measures about 20 feet, Chadee says. It’s home to an estimated 100 trillion bacteria, mostly in the colon: the dry mass of feces, he notes, is about 60 per cent bacteria. It performs a variety of duties, from ingesting nutrients to clearing out toxins. “The immune system is attached to digestion,” says Shelley Burns, a licensed naturopathic doctor and health services director at Scienta Health. “If it’s not maintained, it can cause [other] health issues.”

When the equipment is malfunctioning, it’s not just embarrassing—it can have a debilitating effect. Inflammatory bowel disease, for example, might require long-term medication and surgery; yet there’s still no known cause, and no cure. Most sufferers are diagnosed before they’re 30 years old. “You’re in the prime of your life, and you’ve got pain, cramps and diarrhea,” Fedorak says. “You can’t go to work; you can’t go to school; you’re incontinent and you have to wear a diaper. Unless you can get treated, you’re going to be a fundamentally different person.”

Of course, an upset stomach doesn’t always signify hidden disease. Stress, for example, can alter hormone levels, boosting cortisol and “increasing transit speed through the body,” causing gas, bloating and diarrhea, says Chin. Some medications like painkillers have the opposite effect, slowing the gut down. Bad diet could also be to blame: a lack of healthy fibre or natural lubricants, like olive oil, can lead to constipation, while too much coffee or soda may worsen acid reflux and heartburn, Chin says. “Inflammation of the digestive system will result in bloating, gas and constipation,” adds Burns, who says it can be caused by a lack of good fatty acid (like omega-3) or probiotics, beneficial bacteria that help regulate the digestive system. Hormone dysfunction, food intolerance and enzyme deficiency (which causes lactose intolerance, for example) could also be to blame—all conditions that must be diagnosed by the appropriate health care practitioner, says Chin. “To be truly healthy,” she emphasizes, “you should be symptom-free.”

As the Q-GAP results show, a shocking number of Canadians are not symptom-free. Those who avoid seeking medical help could pay a steep price for their modesty.

Consider Barry Stein. Some years ago, the Montreal lawyer started to find the occasional blood in his stool. “I thought it could be hemorrhoids,” he says. “The few symptoms I had, I ignored.” When Stein was 41, a colleague of his was diagnosed with colon cancer: within three months, he’d passed away. “I thought, ‘I’d better do a colonoscopy,’ ” Stein says. “To everybody’s surprise, not only did I have colon cancer, but it was advanced to the point where they gave me a 30 per cent chance of surviving the next five years.”

That was over a decade ago. Several surgeries and treatments later, Stein (president of the Colorectal Cancer Association of Canada) is cancer-free. Colon cancer is “really the only cancer you can prevent before it happens,” Stein says. If it’s caught in time, “it’s 90 per cent preventable and curable.”

Yet it remains the second leading cause of cancer death in the Western world. Out of shyness or fear, countless people avoid getting a colonoscopy, despite the fact that it’s the best way to find and remove polyps (abnormal growths that can lead to cancer). “It’s a very sad story,” says Dr. Philip Gordon, director of colorectal surgery at Montreal’s Sir Mortimer B. Davis Jewish General Hospital, and a professor at McGill University. He says he finds polyps in 30 to 40 per cent of his patients. Colonoscopies are relatively quick and painless, he adds, but people are “embarrassed about going into a doctor’s office, and showing their bum to a stranger.” (Anyone over age 50 should get a colonoscopy, Gordon says. Those with a family history should begin at age 40.)

Gas, diarrhea and bloating may not be everyone’s favourite topic, but they should no longer be taboo. “A lot of digestive diseases are preventable,” Fedorak says. “What’s the next big killer? Digestive disease is that. We need to bring it to the forefront.”