Digestive health usually gets attention only when something goes wrong. But the truth is, good digestive health is built quietly, through small daily habits repeated consistently over time.

As we recognize World Digestive Health Day this month (May 29), it’s worth stepping back from the trends, supplements, and internet “gut hacks” to focus on what actually works.

Omar Khokhar, MD, a gastroenterologist at OSF HealthCare, says your digestive system is remarkably resilient and if you support it well, it often returns the favor for decades.

One way to avoid digestive issues and inflammation, Dr. Khokhar says, is to avoid eating convenience or ultra processed food.

Avoid ultra processed food

“So for me, ultra processed food is something that comes out of a wrapper, out of a box, out of a can. It’s something that was made in a factory 300 miles away, two months ago that you now see in your local grocery store. So, there is a convenience factor, but we're starting to see that we're paying for that convenience because those foods are difficult to digest and they can result in inflammatory changes to your gut.” 

Dr. Khokhar notes that while genetics can influence the risk of conditions such as celiac disease, inflammatory bowel disease and digestive cancers, daily habits still play a major role in long-term gut health. He says research now shows that when the lining of your gut is disrupted, it can have negative impacts.

“So, the more that we don't do on a daily basis, whether it's fiber, having good bowel movement, making sure we keep a good microbiome, that may result over time in disruption of the mucosal or lining of your stomach and your intestine,” he says.

When that happens, Dr. Khokhar points out, the body will absorb things it shouldn’t, and it won’t be getting what nutrients it should be getting.

If you can only do two things to improve your gut health, Dr. Khokhar says adopt these two habits.

“Flush the pipes. Make sure you drink enough water. Make sure you get enough fiber – whether that’s in diet, whether that’s a supplement, it really doesn’t matter to me at this point. If you get enough fiber and you flush your pipes and you’re evacuating your G.I. tract, it’s going to help remove the waste product.” He adds, “Once you remove the waste product from the colon, everything else can flow down.” 

For fiber, Dr. Khokhar says focus on foods found around the perimeter of the grocery store, including fruits, vegetables, and lean proteins.

Walk after meals

One other good habit to consider – taking a walk after meals. Dr. Khokhar advises even short walks can improve digestion and reduce discomfort.

“After you eat, go for an eight-to-10-minute walk. The activity helps everything, literally from a gravity point of view, a physical point of view, a gas expulsion point of view.” He adds, “It almost helps you reset and recalibrate before you inevitably in our society – we sit back down.” 

A final point from Dr. Khokhar – do not to ignore persistent abdominal pain or major changes in bowel habits. He warns those symptoms can sometimes signal more serious conditions, including colon cancer.

Dr. Khokhar is a gastroenterologist practicing at OSF HealthCare in Bloomington, Illinois.

Clips with Dr. Omar Khokhar 

B-roll-World Digestive Health Day

Though not one of the most common cancers, Marcie Lindstrom, APRN, says she’s seen liver cancer cases rise in recent years in line with national trends. Luckily, the gastroenterology provider at OSF HealthCare says treatment has evolved, too. And it’s another reminder to know your body and see your health care provider regularly because liver cancer is more treatable when caught early.

The liver: A recap

A primer on what the liver does for us: Lindstrom says the liver sits underneath the right ribcage and cleans toxins from our blood, helps digestion and produces proteins needed to live. In other words, it’s not an organ you can live without like a gallbladder or one kidney.

Liver cancer: Hidden and harmful

Lindstrom says primary liver cancer describes when the cancer starts there, and secondary liver cancer is when it spreads there (medical term: metastasizes), most commonly from the lungs, breasts or colon. Secondary is more common than primary.

“There are multiple causes of liver cancer. A person is at a higher risk if they have a damaged liver,” Lindstrom says. “Things that can cause a damaged liver include alcohol. So heavy alcohol use [is a risk]. Viruses that can infect the liver such as hepatitis B and C [are risks]. And we’re seeing an increasing number of people having fatty liver disease. That puts people at risk for liver damage. That damage can progress to cirrhosis [scarring], and cirrhosis puts you at a higher risk.”

These liver issues can be fatal if untreated. And unfortunately, Lindstrom says liver cancer often comes with no symptoms.

Diagnosis and treatment

That’s where regular visits to your primary care provider, and if needed, a specialist like a gastroenterologist or oncologist come in.

Lindstrom says your provider will go over your risk factors: do you have a family history of liver issues? What’s your own health history, specifically with hepatitis? How often do you drink alcohol? What’s your daily diet and exercise routine?

“If we determine somebody has a lot of scarring of the liver, they should be on regular surveillance looking for liver cancer,” Lindstrom urges. “Every six months, they should get some imaging and possibly a blood test that helps to detect cancer.” The person could also have a biopsy of their liver, where a provider will take a sample of liver tissue and send it to a laboratory to find out exactly what’s wrong.

Chemotherapy, radiation therapy, immunotherapy and liver transplant surgery are possible treatments.

“A liver transplant could be required if the tumor isn’t very large, but there’s a lot of damage or scarring of the liver,” Lindstrom explains.

Prevention

Lindstrom says if it’s caught early, liver cancer can be treated and even cured. Some things to keep in mind to avoid the disease:

• Eat a healthy diet, avoiding things like processed food, high sugar food and high fat food that can lead to liver issues.
   
• Get moving to avoid things like obesity, diabetes and high cholesterol. The American Heart Association says to aim for 150 minutes of exercise per week spread out over several days.
   
• If you do develop chronic conditions like diabetes, see your provider regularly to stay on top of managing the issue.
   
• Know your family history of liver and other health issues.
   
• Limit alcohol or avoid it altogether.
   
• There’s no vaccine for hepatitis C, but there is treatment. There is a vaccine for hepatitis B. The United States Centers for Disease Control and Prevention says the shots are safe, effective and have a schedule. Talk to a provider to see if you’re on schedule or if you need a shot now, for example if you’re at high risk.
   
• Take other steps to avoid hepatitis: practice safe sexual relations, avoid blood-to-blood contact with others and don’t share or reuse needles.
  
  “You have a history of blood transfusions prior to 1992. You got a tattoo or piercing in a less than sanitary situation,” Lindstrom lists as other hepatitis risk factors. “I’d recommend getting screened. In fact, it’s a current recommendation to be screened for hepatitis C at least once in adulthood.”
  
  Lindstrom says providers list 1992 as a hepatitis C benchmark because that’s when blood screenings were developed.

Learn more

Read more about how to keep your digestive system healthy on the OSF HealthCare website. Cancer care at OSF HealthCare also includes the OSF HealthCare Cancer Institute in Peoria, Illinois, which provides comprehensive care for the region.

Interview clips

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November, December and January bring bountiful holiday meals.

While it’s tempting to chow down, experts are cautioning about how overindulgence can make you feel mentally and physically crummy in the moment, plus open the door to long-term unhealthy eating habits.

Have the right mindset

Andrew Zasada, MD, provides emergency department care at OSF HealthCare. He says avoiding stuffing yourself starts before you sit down for the meal.

“If you come to the meal hungry, you tend to try to make up for not having breakfast. You load your plate up, which is going to cause you to overeat,” Dr. Zasada says. “Instead, have a light snack an hour or two before you sit down to the meal.

“Put the food in one room and sit down in another room to eat. That necessitates you going there rather than having food available for another fill.”

The meal itself

Enjoy holiday meals, Dr. Zasada says. It’s not a race.

Grab a smaller plate, and take smaller portions of each item. Pretend you’re filling the plate up for a child. You wouldn’t take five rolls and two big slabs of meat for a youngster, so don’t do it for your adult self.

Other tips: Chew slowly. Between bites, put your utensil down, take a drink of water and talk to someone. This allows your stomach to fill up and tell your brain that you’re full.

When you finish eating, leave the table, and go to another room. Staying next to the food increases the temptation to keep nibbling.

If you can’t help it

Dr. Zasada says despite our best efforts, sometimes you overeat during holiday meals. Maybe you don’t want to offend your aunt by not having a slice of her famous pie.

If that happens, Dr. Zasada says there are two pitfalls to avoid: Drinking alcohol and lying down right after the meal.

“That opens up the sphincters of your stomach, slows down digestion and increases the chance for heartburn,” Dr. Zasada says.

Try tea or coffee after a meal instead of alcohol. But if you must indulge in a spirit, Dr. Zasada says to wait at least 90 minutes so your stomach can partially empty.

Instead of lying down for that post-meal nap, sit upright, talk to people or play a game. If the weather is nice, go for a walk.

A word on more serious eating issues

Holiday meals may be difficult for people who suffer from eating disorders, such as binge eating (eating a lot in one sitting and feeling you can’t stop), anorexia nervosa (an unwarranted fear of being overweight which leads to things like starvation) or bulimia nervosa (taking unhealthy steps to avoid weight gain like purging your food).

Dr. Zasada says, in the moment, you should have someone you trust who can help you through the holiday meal and check in with you later. Long term, he says these are serious issues that should be talked about with a health care provider.

“Repeated bulimia will damage your teeth. It’s corrosive. You lose electrolytes when you vomit,” Dr. Zasada says. “You become sick. If you do this repeatedly, you will lose weight in an unhealthy way. You will possibly dehydrate. You will start losing muscle mass.

“It’s just not a good thing.”

Bottom line: Don’t get discouraged

Dr. Zasada says one day of extra eating may make you feel bad, but it isn’t going to derail your overall health.

“One day won’t make you fat,” he says.

Get back into your healthy eating habits the next day while enjoying those leftovers in moderation. If you feel you are struggling to maintain a healthy weight or body image, talk to your primary care provider. They may refer you to a specialist like a dietitian or mental health provider. From there, plans could include a diet and exercise regimen, medication or, in rare cases, weight loss surgery.

Interview clips

For mom

Anderson says it’s no problem for pregnant women to have onions in their diet.

“They are very rich in antioxidants. That’s something we don’t get a lot of. They’re really high in vitamin C,” Anderson says. “They have fiber, magnesium and potassium. Fiber and magnesium help with digestion, and magnesium helps with cramps. Potassium is really good for blood circulation and blood pressure.”

But, there are the usual precautions. When adding raw onions to a meal (a salad, for example), wash them to remove any bacteria. And don’t overindulge. For example, don’t have a greasy, processed cheeseburger as an excuse to get your daily onion intake.

“Onions are a high FODMAP food, which means there are carbohydrates that are harder for some people to digest,” Anderson adds, noting that a woman’s digestive system changes a lot when carrying a baby. “So if you have a sensitive digestive system, onions could cause bloating. If you have irritable bowel syndrome, onions can make that flare up. Cooking onions helps break down some of those carbohydrates and aids digestion.”

For baby

Infants should consume breastmilk or formula exclusively for at least the first six months, Anderson reminds. But after that, introducing onions is like introducing any other food: Slow and steady wins the race.

One option: Sauté some onions to soften them, cut the food into small pieces to prevent choking then work the onions into the store-bought baby food.

“Make it easy for baby to chew. They’ve never had to do that before,” Anderson points out. “It’s good to let them learn how to chew, but we need to make sure the foods are easy to chew.

“Onions help develop a baby’s palette,” Anderson adds of the benefits of the vegetable. “Experts are finding that introducing strong flavors like that can prevent picky eating in the future.”

Precautions and warning signs to know: If the baby is extra fussy or gassy or has an allergic reaction like a rash or diarrhea, take the onions out of the diet and see if that improves things. See a health care provider if symptoms don’t improve.

Myth vs. fact

Do a web search for “babies and onions,” and you’ll find a lot of claims.

• Can onions help with colic, a condition where a healthy baby cries for a long time? Not so fast, Anderson says. In fact, onion-induced gassiness could make the baby even more fussy.
   
• Some say putting an onion in my baby’s crib or sock or giving them onion water can help with baby’s health. 
  
  “It’s supposed to draw out toxins,” Anderson says, repeating what she calls an “old wives’ tale.”
  
  But, Anderson says science doesn’t back the claims up. In fact, onions can irritate a child’s skin and eyes.
   
• Can eating onions help with teething, when the baby’s teeth emerge? There’s actually some truth to this one, Anderson says. To try it, skip other types and focus on green onions. Let the food cool in the refrigerator before giving it to the little one.
  
  “It’s teaching them to bring things to their mouth and chew. It’s a food that’s cool and not super hard. As they chew, it will break down. But it’s not going to disintegrate in the mouth,” Anderson says.
  
  All this can help with pain and inflammation, Anderson says. Just watch your youngster at all times while chewing.

Learn more

Read more about how to have a successful pregnancy and birth on the OSF HealthCare website. The health system or social service agency near you may also offer classes to master baby feeding.

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There’s renewed optimism for people with fatty liver disease, sometimes called NASH (non-alcoholic steatohepatitis) or MASH (metabolic associated steatohepatitis). The United States Food and Drug Administration recently approved the first medication, Rezdiffra, that can directly address liver damage as the person makes lifestyle changes.

“This is a gamechanger for anyone who has fatty liver disease with moderate to severe liver scarring,” says Marcie Lindstrom, APRN, a gastroenterology provider at OSF HealthCare. “This can reduce the number of complications that can develop with worsening scarring.”

Fatty liver basics

The liver is an important organ. Experts even call it a miniature factory inside us. The liver detoxifies medication; releases glucose to give you energy; aids digestion and makes cholesterol, proteins and amino acids.

Obesity, diabetes, high cholesterol and excessive alcohol use can lead to fatty liver disease, which Lindstrom says impacts around one in four people worldwide. Left untreated, scarring from fatty liver disease can progress to cirrhosis, or severe scarring. Complications from cirrhosis can include enlarged blood vessels in the esophagus which can lead to life-threatening bleeding, fluid overload called ascites, liver cancer and liver failure necessitating a transplant.

How we got here, where we’re going

Lindstrom says before Rezdiffra, people with fatty liver disease could only make those lifestyle changes to try to get better: control your blood sugar, cholesterol and weight.

“Strictly on the shoulders of the individual,” Lindstrom reiterates.

“We know that people who lose 5 to 10% of their body weight are able to make improvement with fatty liver disease. It is considered a reversible condition,” she adds.

Now, Rezdiffra is an option for people with moderate to advanced scarring.

“It works on thyroid-B receptors in the liver. We normally think of thyroid receptors in our thyroid gland [in our throat], but we do have thyroid beta receptors elsewhere. A lot of them are in the liver,” Lindstrom explains. “The medication works to release triglycerides from the liver. It improves and may even resolve fatty liver.”

It’s a once-a-day pill, Lindstrom says, and there’s no “one size fits all” for how long you need to be on it. Side effects include nausea and diarrhea, but Lindstrom says studies have shown those get better after three weeks. She also says women who are pregnant, are about to become pregnant or are breastfeeding should not take Rezdiffra. There hasn’t been enough study of the drug to see how it impacts those groups.

The bottom line: you can talk to your health care provider to see if Rezdiffra is right for you. Be sure to mention what other medicines you are taking so your provider can see how Rezdiffra might interact.

“If somebody is taking a statin for cholesterol levels,” for example, Lindstrom says. “It’s not that we want them to go off their statin. There are certain limitations to the dosage.”

Learn more

Learn more about how to avoid fatty liver disease and other gastroenterology care tips on the OSF HealthCare website.

Interview clips

The United States Food and Drug Administration recently approved the first treatment for people with liver scarring due to fatty liver disease. It's welcome news for people battling the disease.

How did we get here?

In some ways, it goes back to the obesity epidemic in the United States. Obesity brings an increased risk of fatty liver disease, an ailment that’s treatable but could mean serious complications. Moreover, health experts say isolation during the pandemic led may to increase alcohol intake, another risk factor for fatty liver.

David Rzepczynski, MD, a gastroenterologist at OSF HealthCare, describes the liver as an “extremely important” factory for the body. It performs many functions, like detoxifying medications, aiding digestion and making cholesterol, proteins and amino acids that help the body function. And have you ever missed a meal? You can thank your liver for releasing glucose and giving you energy.

All those “factory functions” make it critical to be watchful of fatty liver disease. As the name suggests, the disease describes an accumulation of fatty cells in the liver. Dr. Rzepczynski says it takes just 5% of cells with increased fat to make a diagnosis, but some obese people have 100% of cells with fat.

Hepatitis C and excessive alcohol use can cause fatty liver disease or are at least linked to it. But you can still get fatty liver if you’re not a heavy drinker, and that’s where your weight comes into play.

“The big driving force of fatty liver disease is what we call the metabolic syndrome,” Dr. Rzepczynski explains. “There are five factors: obesity, diabetes, hypertension [high blood pressure], high cholesterol and insulin resistance.”

Dr. Rzepczynski adds that fatty liver disease may cause pain in the upper abdomen, but it mostly comes without symptoms. So if any of those five risk factors apply to you or if you’re a heavy drinker, don’t wait. Talk to your health care provider about getting your liver looked at.

A doctor will likely start with a blood test, Dr. Rzepczynski says. An ultrasound or biopsy may also be needed. The next step: lose weight.

“It doesn’t have to be getting back to your ideal body weight,” Dr. Rzepczynski says. “Losing 5% of your weight can reduce fat in the liver. Losing 7% will help reverse some of the inflammation associated with fatty liver. And some studies have even shown that losing 10% or more might reverse some of the scarring.”

While it may be a bit alarming, left unchecked, fatty liver disease can lead to a serious condition called cirrhosis, or scarring, of the liver.

“You have normal liver tissue replaced by scar tissue,” Dr. Rzepczynski says. “When that occurs, you have a loss of liver function. You have less liver cells performing their duties.”

Cirrhosis of the liver can cause the organ to fail, making a transplant necessary. Liver issues can also mean an increased risk of heart disease, stroke and cancer, particularly breast and colon cancer.

Learn more about fatty liver disease and other gastroenterology care on the OSF HealthCare website.

Interview clips