coffee beansImagine:  John Wayne in True Grit, charging bad guys on horseback, with the reins in his teeth, a Colt revolver in one hand and a Winchester rifle in the other, and suddenly, he veers off and heads for the woods.   He’s acutely regretting that cup of coffee he had back at the campfire.

Well, that didn’t happen, because he’s John Wayne.  But it certainly might happen to us lesser mortals.  In fact, this laxative effect is a known consequence — or, hey! It’s a benefit, depending on how you look at it – of drinking coffee.  The effect can happen in as little as four minutes, according to an English study published in the journal, Gut.

Why does coffee make some people need to poop?  Several reasons.  It’s not the caffeine (decaf can produce the same effect), and it’s not the heat of the beverage; the English scientists tested drinking hot water in the same group of study participants, and nothing happened.  Out of 14 people studied (12 men, two women), eight of those who drank black, unsweetened coffee needed to move their bowels.  The coffee sped up the gut’s motility – movement of food through the digestive tract, using a series of muscle contractions called peristalsis – in the eight responders, but not in the others.  “The increase in rectosigmoid motility induced by coffee lasted at least 30 minutes,” the scientists reported.  “These results suggest that drinking coffee can stimulate a motor response of the distal colon in some normal people.”

The fact that this happened so darned fast, the researchers speculated, doesn’t mean that coffee actually rockets through the system.  Instead, “we suspect that coffee may induce a ‘gastrocolonic response’ by acting on epithelial receptors in the stomach or small bowel.”  This might be activated by nerves or hormones in the GI tract; also, they added, “coffee has been shown to promote release of gastrin, which can increase colonic … motor activity.”  So for some people, coffee shifts the gut into temporary fast-forward mode. 

Why Does Coffee Make You Poop?Coffee is a great way to wake you up, and it’s also a great way to keep you regular. What’s so special about coffee that it makes you poop?—–For a collection of all our videos, check out TestTube Video!

Posted by Discovery News on Wednesday, July 29, 2015

What else does it do?  I am fortunate to be married to an excellent gastroenterologist, Mark Worthington, M.D., formerly on the medical faculty at the University of Virginia and Johns Hopkins and now in private practice in Arizona.  “Basically, coffee causes a net secretion of fluid into the small intestine,” he says.  “For most people, the colon takes up the slack – it sucks up the extra water – but it gets activated in the process.  For some people, coffee actually leads to diarrhea because the colon can’t handle it all.”  People who particularly have trouble with coffee, he adds, are those with colitis (inflammation of the colon).  Also: “coffee sweeteners, such as Stevia, can cause diarrhea in some people.”  If you add a lot of dairy to your coffee, and dairy products are difficult for you, this might make coffee a bit of a digestive challenge, as well.

Is that it?  Well, no, there’s the acid.  Coffee is loaded with a phenol called “chlorogenic acid,” and – again, not in everyone – for those of us who lack cast-iron stomachs and are already prone to acid reflux, or for people who drink coffee on an empty stomach, the acid can irritate the stomach lining.  This is called gastritis, and it can result in heartburn, hiccups, pain in the belly, nausea, and can even make you throw up if you don’t get some food in there to help combat the acid.  Caffeine itself – let’s face it, the major reason we drink coffee – also can cause the stomach to pump out more acid.   

Note:  Don’t think I’m anti-coffee.  I’m not at all.  Coffee also does a lot of good things, including help lower your risk for Alzheimer’s disease, which I will talk about in some future post.  This is not that post.

Good news for your tummy:  If coffee starts your day off with an upset stomach or gives you the rumblies, don’t despair:  You are not alone.  In fact, there are so many people with this problem that gut-friendly coffees – with more available all the time – have been developed just for you.

Which is good news.  However, if you’re one of those susceptible to coffee’s Number Two side effect – no matter how gentle or organic or gourmet your coffee may be — you’ll still probably have to poop after you drink it.

©Janet Farrar Worthington

Soothing heartburnEarlier I wrote about the causes of heartburn, also called GERD (gastro-esophageal reflux disease). Now, let’s talk about how to make it better.

First scenario: You’re minding your own business, it’s late at night, you have an attack of heartburn, and you don’t have any medicine. What can you do? Well, you can go to the pantry, and make your own antacid by mixing up 1/2 teaspoon of baking soda in half a glass of water. It will neutralize the acid. But as with any antacid (see below), the effect won’t last forever. Some foods are soothing for the acid-inflamed stomach, as well. Soda crackers (like Saltines) have baking soda, and can help soak up the acid. Also, apples are your friend. Just eating a plain old apple can help disarm the stomach acid. Some people swear by apple cider vinegar:  A tablespoon, mixed with a tablespoon of honey in a cup of warm water can provide temporary relief, as well.

But this is just emergency stuff, best for the occasional flare-up.

The next scenario:  It’s not your first rodeo. You have noticed that you’ve been having heartburn lately, so you’ve bought some Tums. Well, okay. The problem here is that Tums contain calcium carbonate. They will buffer the acid and give you immediate relief. But the calcium actually causes the acid level to bounce back — higher than it was before you took the Tums. This is called rebound hyperacidity. “So an hour later, you are making more acid than you did before, and you’re taking another Tums,” says Prescott, Arizona, gastroenterologist Mark Worthington, M.D. (Disclaimer: I happen to be married to Mark, an excellent, caring physician who was on the faculty at the University of Virginia for 10 years and then on the faculty at Johns Hopkins for five. He’s in private practice now.)

You probably don’t want to live this way, with one surge of stomach acid following another in big, unpleasant waves. Tums are not a good long-term solution for chronic reflux, so let’s move on to drugs.

The next level up from Tums is other antacids:  Rolaids, Maalox, Mylanta, and Gaviscon. These are different from Tums in the chemicals they contain (the names for these compounds end in oxide and ate): Rolaids have calcium carbonate magnesium hydroxide. Maalox and Mylanta contain aluminum hydroxide and magnesium hydroxide, and Gaivscon has aluminum hydroxide and magnesium carbonate. You can get these kinds of antacids as chewable tablets, dissolving tablets, as chewing gum, and in a liquid form. Some of them have a bonus ingredient, like simethicone, which can subdue the gas bubbles percolating in your stomach; Gaviscon’s bonus ingredient is alginic acid, which foams and helps keep what’s in your stomach from creeping back up the esophagus.

“These work for people with heartburn that is occasional and not too severe,” says Worthington, “although the magnesium can cause loose stools (diarrhea).”

However, if you have more frequent bouts of heartburn, you need to move on to the next room in the acid-resisting bunker:  Acid Reducers, also called H2 Receptor Antagonists, or H2 Blockers. These drugs end in “idine.” Pepcid (famotidine), Zantac (ranitidine), Tagamet (cimetidine), Axid (nizatidine). Pepcid Complete combines an acid reducer with an antacid, so it gives immediate relief and then keeps the acid down. Interestingly, although they’re high on the ladder of heartburn remedies, doctors don’t even think of them as particularly high-powered. “These are okay reflux drugs,” says Worthington. “They don’t suppress acid as much as proton pump inhibitors do,” (see below), “which some people see as a benefit.” Why a benefit? Well, if you can get away with taking this level of drugs and having your symptoms controlled, you can still get some of the good out of stomach acid. Long-term lack of stomach acid can lead to bacterial overgrowth (an excess of bacteria) in the small intestine, and a deficiency of magnesium, iron, calcium, and other trace minerals — because it turns out that you need some acid to absorb them.

And that brings us to the big guns:  Proton Pump Inhibitors. These drugs are the “prazoles.” Prevacid (lansoprazole; note: this is different from the less powerful version of Pepcid discussed above), Prilosec (omeprazole), Protonix (pantoprazole), Nexium (esomeprazole), Dexilant (dexlansoprazole), Aciphex (rabeprazole). Some of these require a prescription. The good thing is, because they pretty much dry up all the acid in your stomach, they give your poor inflamed esophagus a chance to heal.

And this is really important because your esophagus can only take so much. So if your doctor thinks you need a proton pump inhibitor, you should take it. Because if you don’t treat GERD, it can damage your esophagus. Inflammation in the esophagus, called esophagitis, hurts, and makes it difficult to eat, because you’re in discomfort. Worse, long-term esophagitis can lead to a condition called Barrett’s esophagus — which, in turn, can lead to cancer. This is diagnosed with an upper endoscopy, and the good news is that there is treatment for it, called radiofrequency ablation. “We basically zap the lining of the esophagus with radio waves,” says Worthington. “This causes a very defined, superficial burn, and the Barrett’s tissue sloughs off. It’s like getting a sunburn in the esophagus, but it can save your life.”

There is also a condition called a Schatzki ring. “This is a shelf of scar tissue between the stomach and esophagus,” says Worthington, “and food can get hung up on that when you swallow. It’s called ‘steakhouse syndrome,’ because it’s usually a big piece of steak that gets stuck in there. You feel like you’re having a heart attack, but it’s really just the esophagus having a spasm around the food.” Long-term damage to the esophagus can also lead to development of a stricture — more scar tissue, but instead of a ring, it’s a progressive narrowing, so that food can’t go down very easily. This can be opened up during upper endoscopy, as a gastroenterologist makes tiny cuts in the scar tissue to relax its stranglehold on the esophagus.

Finally, there is surgery, a procedure called fundoplication:  taking the top of the stomach and wrapping it around the esophagus to create an artificial valve — so that what happens in the stomach stays in the stomach. “It works pretty well,” says Worthington, although with this procedure in place, “you can’t burp and you can’t vomit, because if you do, you could rip the stitches.” The fundoplication may not last forever. “They do tend to stretch a little over time, but for people with the most severe reflux, it is not an unreasonable thing to do.”

If you keep having heartburn more than twice a week, what should you do? Well, you can try the lifestyle and diet changes written about in the previous post. If those don’t make your symptoms better, you can start on the remedies here, but the best thing you could do would be to get an upper endoscopy (done by a gastroenterologist, so you’ll need a referral from your primary care doctor), to make sure you don’t have any damage to the esophagus that needs more serious treatment.


©Janet Farrar Worthington