First things first: Anyone with chest pressure, an abnormal heartbeat, or shortness of breath MUST see his or her doctor immediately to rule out serious heart conditions that can cause these symptoms, including arrhythmias, valve disease, coronary artery disease, and pericarditis. If this workup is negative, your doctor should then examine your lungs. If both heart and lung tests are negative, there is a chance that a gastrointestinal disorder is causing your symptoms. Some of the digestive disorders that can cause chest pain include gastroesophageal reflux disease (GERD) and motility disorders, such as diffuse esophageal spasm, achalasia, and other, less common syndromes. Your doctor may prescribe a gastrointestinal workup, perhaps including a barium swallow (an X-ray test), endoscopy, and/or an esophageal motility study. Q2. I’ve always been very constipated and if I don’t drink “dieter’s tea” I won’t go to the bathroom. I have tried Metamucil and healthy fiber as alternatives, but nothing else works. Is dieter’s tea bad in the long term? — Lucerito, California Unfortunately, so-called dieter’s tea is not regulated by the Food and Drug Administration (FDA). It can be obtained at health food stores, on-line, or through mail-order catalogs. You should know that the FDA has received adverse reports related to dieter’s teas, including the deaths of four young women in whom dieter’s tea may have been a contributing factor. While some studies have shown that dieter’s teas may be better than placebo in relieving constipation, they contain a variety of plant-derived laxatives that may cause long-term harm. For example, many dieter’s teas contain senna, a stimulant that causes the nervous system of the gut to release neuropeptides (nerve proteins that regulate and link our body systems). These promote defecation by increasing movement of the gut or stimulating fluid secretion. Long-term use of stimulants such as senna may deplete the gut of these neuropeptides and ultimately lead to worsening of long-term constipation. In other words, dieter’s teas do carry a long-term risk of harm; I would recommend you opt instead for fiber products, mineral oil as a safe stool softener, or an osmotic agent such as lactulose, sorbitol or MiraLax as they are safer in the long term. Mild constipation can also be treated by an increase in drinking liquids, physical activity, and behavioral changes that normalize the time of day when defecation is attempted. Q3. Is it true that if you have celiac disease, you should not eat condiments that contain white vinegar? What about distilled vinegar – is that safer? — Jill, Ontario White vinegar and most vinegars are typically distilled; the distillation process removes all gluten products. In the United States, vinegars are routinely distilled and made typically from corn, potatoes, or other food substances, but even distilled vinegars made from wheat are safe for people with gluten intolerance because the gluten products are removed in the end product. However, exceptions include malt vinegars (made from barley); flavored vinegars, which may contain gluten; and some imported vinegars that have wheat products added after distillation. Vinegars used in condiments made in the United States are typically safe for patients with celiac disease. Q4. I was recently diagnosed with fructose malabsorption disorder. It’s been really tough to control my diet, since fructose is in so many products. Any advice? Fructose malabsorption has been thought to be relatively rare compared with malabsorption of other sugars, particularly lactose. There is an inherited form of fructose malabsorption, but it is very rare and is related to a mutation in a specific gene (GLUT5) that normally makes a protein that helps transport fructose in the digestive tract. However, in recent studies malabsorption of fructose and another sugar, sorbitol, has been found in a number of patients who had previously been diagnosed with irritable bowel syndrome. In addition, there appears to be overlap between fructose malabsorption and celiac sprue, an inflammatory condition of the small bowel that is treated by avoiding gluten, a component of wheat products. For this reason, adults who are found to have fructose malabsorption disorder should also be tested for celiac sprue. Regarding treatment, you’re doing the right thing to avoid foods that have high fructose content. I know that means work on your part, since so many foods contain fructose (including high-fructose corn syrup). Try in particular to avoid fruits and fruit products that have high fructose levels — such as apple juice, pears, peaches, and prunes — and limit your intake of foods that contain high levels of sucrose (table sugar) as well, since sucrose also contains fructose, although in a bound form that is somewhat easier to tolerate for patients with fructose malabsorption. Learn more in the Everyday Health Digestive Health Center.
