“Looks like cheese,” I thought to myself as I inspected the inside of Deborah’s stomach with the endoscope. Unfortunately, this was at 8:30 in the morning and Deborah’s last meal had been at 10 p.m. the night before. Within 90 minutes after eating, at least 50% of the contents of your stomach should already have emptied into the small intestine. A stomach full of undigested food 10.5 hours later – this was definitely abnormal.
I had been seeing Deborah for several months for episodes of abdominal pain. My first thought had been acid reflux, which, as I like to tell my patients, is not really a disease. Reflux is your body knocking on your door saying, “I don’t like how you’ve been treating me. All that caffeine and alcohol and cheesecake and burgers is making me sick.” You don’t need your doctor to tell you what’s going on – your body is telling you! You just need to listen.
Lifestyle modifications (aka “listening”) remain the cornerstone of therapy, but alas, a harder pill to swallow than the little purple pill. The little purple pill and other acid blockers do a great job at neutralizing stomach acid. When we put someone on one of these drugs, within a few days they usually call to say how much better they are. The problem is these drugs work so well that people have no incentive to mend their ways – as long as they take their pill they can often continue to eat pizza at 10 p.m. and feel just fine.
But Deborah, after more than 3 months of treatment wasn’t feeling just fine – in fact, she was feeling awful and continuing to have daily episodes of abdominal pain. That’s when we decided to take a look inside her stomach and after just one glimpse I knew exactly what her problem was: cheese pizza that was still sitting there 10 hours later!
The technical term for Deborah’s condition is “gastroparesis” which means paralysis of the stomach – affectionately referred to as a “lazy stomach”. We see this condition commonly in diabetics because the disease can affect the nerves that control emptying of the stomach. But why are we seeing gastroparesis in so many non-diabetics like Deborah? Because we’re spending the majority of our day sitting at a desk hunched over a computer and that couldn’t be more at odds with our hunter-gatherer ancestry and design.
The gastrointestinal tract, including the stomach, is one long muscle and like any other muscle, inactivity makes it weak and flabby. The other really interesting thing about our gastrointestinal tract is that it has a bedtime. Our intestines are most active first thing in the morning and least active at night. So what do so many of us do? Starve ourselves until dinnertime and then dump 1000 calories into a sleepy gastrointestinal tract and lie down an hour later just in case gravity thought it would lend a hand. Our bodies are programmed to need a certain minimum number of calories to survive. If you don’t get them in the morning and early afternoon when you need them the most you’ll end up consuming them at night – when you really don’t need them and they’re likely to sit in your stomach for hours.
The story does have a happy ending: Deborah adjusted well to a schedule of small frequent meals, beginning with a robust breakfast and ending with a strict 7 p.m. dinner curfew and is now pain-free on no medications.