Intestines

When you tell someone you hate his guts, it''''s not a very nice thing to say. But then again, guts are a pretty gross concept. Several yards of pink innards coiled just below your stomach and liver like a giant worm--they could hardly be described as cute.

But the small and large intestines are integral parts of your digestive system. While some of the chow you consume is digested in the stomach, it''''s the small intestine that adds more digestive enzymes and completes the job. There the digested food is absorbed through the intestinal walls and enters the blood.

The large intestine, just below the small intestine, takes the indigestible parts of the food and gradually absorbs the liquid from it. The semisolid waste is then formed into feces and pushed down into the rectum for evacuation.

Despite its name, the small intestine is actually longer--measuring in at a whopping 20 feet. The large intestine, although wider in diameter, is just 5 feet long.

Keeping Your Pipes in Order

Having intestinal fortitude means that you can suffer the slings and arrows of outrageous fortune without even breaking a nail. But intestinal health is another matter.

To keep your intestines in the pink--and your body free of gas and diarrhea--follow these tips from top docs.

Avoid too much of a good thing. Fresh fruits and fruit juices are important in a healthy diet, but in rare cases, they can bring on intestinal distress. Fruits, honey and especially fruit juices are high in a type of sugar called fructose. Normally, enzymes in the intestinal wall break down fructose so it can be absorbed, but sometimes, when too much of the sugar is ingested at one time, some may escape through the small intestine into the colon, says Charlene Prather, M.D., a gastroenterologist and director of the Motility Clinic at the Mayo Clinic in Rochester, Minnesota.

Fructose that arrives at the colon undigested is readily fermented by the bacteria that live there. Their feast may result in gas, bloating and sometimes diarrhea. Fruits also contain soluble fiber and can cause a lot of bacterial fermentation and gas when it reaches the colon.

Including plenty of fruit in your diet is still a good idea, but limit the amount of fruits and fruit juices you consume at any one time. Fruit juice can be more of a problem than fruit, so eat your fruit instead of drinking it, adds Dr. Prather. The recommended amount is two to four servings per day, says William B. Ruderman, M.D., practicing physician at Gastroenterology Associates of Central Florida in Orlando. But that doesn''''t mean all at one sitting. Have a piece of fruit now and a glass of fruit juice later--or make fruit a regular part of your meals.

Skip the sugarless chew. Some sugar-free gums contain sorbitol, which is used as a sweetener. Our bodies are not really designed to handle the relatively large amounts of sorbitol that are present in sugarless chewing gum--and it doesn''''t take much to cause gas and diarrhea, advises Dr. Prather. A single stick of sugarless gum may contain 2 grams of sorbitol--and 5 grams is enough to cause trouble--so by the time you''''re chewing your third stick, you could be headed for gastric grief. That doesn''''t apply to everyone, however: Some people can take 20 to 50 grams before their intestines act up.

The reason? "Although we don''''t absorb sorbitol well, the bacteria that live in our colons absolutely love it," says Dr. Prather. They break it down (in a process called fermentation) and produce large amounts of gas. This gas causes swelling of the colon and pain, which can be compounded by sharp contractions of the muscle in the colon wall. This you feel as cramps. The by-products of fermentation also cause water to flow into the digestive tract, loosening stools and causing diarrhea.

Sorbitol is also found in many "dietetic" candies and is used as a sweetener in some medications. Two other sweeteners--xylitol and mannitol--may have effects similar to those of sorbitol. Any of them may masquerade under the name "sugar alcohol" on gum wrappers and elsewhere.

Juggle your antacids. Antacids offer relief from heartburn, but that immediate relief may mean misery later. Depending on the amount you take, antacids containing magnesium can cause loose stools or diarrhea. That''''s because magnesium pulls water from the body into the intestines. On the other hand, antacids containing aluminum can cause constipation. In either case, you''''re not likely to make the connection, because the symptoms can be very delayed.

So what''''s the solution? First, try adjusting your dose. Generally speaking, the more antacid you take, the more likely you''''ll experience diarrhea or constipation, says Kenneth Lem, Pharm.D., lecturer in clinical pharmacy and associate dean for educational affairs at the University of California School of Pharmacy in San Francisco. If you take antacids often, switch between a magnesium-based one and an aluminum-based one, he says. If you use antacids only occasionally, he recommends using a balanced antacid with both magnesium and aluminum.

"Every time we swallow food or drink, we''''re also swallowing air," says Dr. Prather. "Though much of this swallowed air is burped up, swallowing can still add significantly to the amount of gas in the digestive tract, increasing the likelihood of gas discomfort."

Chewing gum, stress-induced swallowing and drinking carbonated beverages are also major sources of gas.

Beware that time of the month. "Many women may not be aware that gut disturbances can come with their monthly periods," says gastroenterologist Marvin Schuster, M.D., director of the Division of Digestive Diseases at Johns Hopkins Bayview Medical Center and professor of medicine at Johns Hopkins University School of Medicine in Baltimore. "Diarrhea is the most common symptom, usually occurring the first two days of the period. It may also occur right before the period."

This gut disturbance may be directly related to increased levels of the female hormones estrogen and progesterone--both of which relax the colon muscles. "Most of the contractions of the colon are involved in halting the movement of the stool," says Dr. Schuster, "so if you obliterate this braking action of the colon, then you get diarrhea."

Women who have these symptoms can treat them with an over-the-counter anti-diarrheal drug containing loperamide hydrochloride, such as Imodium A-D. Or, if you have abdominal cramps without diarrhea, your doctor might prescribe an antispasmodic drug such as dicyclomine hydrochloride, as in Bentyl, says Dr. Ruderman.

See also Digestive System