Digestive health: 3 strategies to either do or not

The Bottom Line

  • Proton pump inhibitors should be used at the lowest dose possible and for the shortest amount of time needed to treat conditions like heartburn.
  • In children and adults on antibiotics, taking probiotics reduces the risk of Clostridium difficile-associated diarrhea. Those living with irritable bowel syndrome and chronic constipation may also benefit from probiotics.
  • Currently, there is a lack of high-quality evidence around the use of cannabis or cannabis oil for treating adults with active Crohn’s disease or ulcerative colitis. No concrete conclusions around benefits or harms can be made at this time.
  • Discuss the medications and alternative or complementary therapies that you are using or are interested in with your health care team. Together, you can determine what options are safe and appropriate for you, as well as identify the next steps in your treatment plan.

When it comes to digestive health issues, what is the first thing that springs to mind? Constipation, diarrhea, hemorrhoids? While all of these are valid, our digestive system starts at the mouth and ends at the anus. This means digestive conditions and diseases can impact those two areas and lots of things in between. For those of us with digestive issues, speaking about our condition can sometimes make us feel shy or embarrassed, making it easier to downplay our illness and harder to seek help and manage it. But digestive issues are no laughing matter. In 2020 alone, more than 265,000 older adults aged 60 and over died from a digestive disease in Canada (1). Not to mention the countless others living with digestive conditions that impact their quality of life and day-to-day activities. With various traditional, complementary, and alternative treatments available, it can be hard to parse out what works and what one should avoid. From antacids to cannabis, let us look at three strategies for common digestive issues. Click on the links below to learn more.

1. Acid-blocking drugs

Do you feel the burn—heartburn, that is? And are you using prescription-strength antacids, also known as proton pump inhibitors (PPI) to treat it? You are not alone! Millions of people are prescribed PPIs, which are medications that decrease the amount of stomach acid produced (2). Although effective, over the years, there has been a move to reduce the prescribing of these medications, as their long-term use can result in making things worse, as well as other health issues (2;3). Research shows that PPIs should be prescribed to patients at the lowest dose and for the shortest amount of time needed. Those taking PPIs should regularly be assessed by their health care team to determine whether they can slowly reduce the amount taken and eventually stop using them altogether (4-6). Alternative and safer treatment options for heartburn include making lifestyle changes, such as altering what you eat or drink, and, if needed, combining these strategies with over-the-counter antacid pills or tablets (2). Not sure if you are using a PPI? Speak with your health care team to find out and to develop a plan that helps you slowly stop using these medications if and when it is safe to do so. Also, if you are interested in using over-the-counter antacids, this should be discussed with your health care team to understand potential harms, as well as their accepted dose, frequency, and duration of use.

2. Probiotics

What do cultured dairy products like yogurt and fermented veggies like sauerkraut and kimchi have in common? Answer: they all contain probiotics. Probiotics are "good" bacteria that help to break down food and ward off "bad" bacteria. In addition to the foods mentioned above, they can be found in foods fortified with probiotics and can also come in supplement form. Antibiotics, which are heavily prescribed medications, can upset the balance of "good" and "bad" gut bacteria (7;8). This can allow infections caused by a bacteria called Clostridium difficile to occur, leading to potentially fatal diarrhea and bowel diseases (9). Research shows that probiotics given alongside antibiotics lower the risk of developing Clostridium difficile-associated diarrhea in children and adults (10;11). Irritable bowel syndrome and chronic constipation are additional gastrointestinal problems that may also benefit from probiotics (12). Always take medications as prescribed by your health care team and consult them regarding any changes to your diet or if you are considering taking supplements.

3. Cannabis

Millions of people in North America live with an inflammatory bowel disease—namely, Crohn’s disease or ulcerative colitis (13;14). These conditions are generally treated with prescription medications, which can put users at a greater risk of developing serious side effects, such as liver problems and cancer (15-19). Cannabis has emerged as a potential alternative treatment option. Overall, research shows there is a lack of high-quality evidence on the use and effects of cannabis or cannabis oil to treat adults with active Crohn’s or ulcerative colitis. As such, we cannot currently make concrete conclusions about their safety or effectiveness (15;17). If you have inflammatory bowel disease and are still interested in trying cannabis or cannabis oil, consult with your health care team to discuss potential harms and benefits, as well as next steps.

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  1. Statistics Canada. Deaths, by cause, chapter XI: Diseases of the digestive system (K00 to K93). [Internet] 2022. [cited October 2022]. Available from https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310014801&pickMembers%5B0%5D=2.21&pickMembers%5B1%5D=3.1&cubeTimeFrame.startYear=2016&cubeTimeFrame.endYear=2020&referencePeriods=20160101%2C20200101
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  6. Health Canada. Summary safety review – proton pump inhibitors – assessing the potential risk of Clostridium difficile infection. [Internet] 2016. [cited October 2022]. Available from  http://www.hc-sc.gc.ca/dhp-mps/medeff/reviews-examens/ppi-ipp-eng.php
  7. Government of Canada. Canadian antimicrobial resistance surveillance system report 2016. [Internet] 2016. [cited October 2022]. Available from: https://www.canada.ca/en/public-health/services/publications/drugs-health-products/canadian-antimicrobial-resistance-surveillance-system-report-2016.html#a3-2-2
  8. Centers for Disease Control and Prevention. Get smart: Know when antibiotic work in doctor’s offices. [Internet] 2017. [cited October 2022]. Available from https://www.cdc.gov/getsmart/community/programs-measurement/measuring-antibiotic-prescribing.html
  9. Oake N, Taljaard M, van Walraven C, et al. The effect of hospital-acquired Clostridium difficile infection on in-hospital mortality. Arch Intern Med. 2010; 170(2):1804-1810. doi: 10.1001/archinternmed.2010.405.
  10. Johnston BC, Ma S, Goldenberg JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: A systematic review and meta-analysis. Ann Intern Med. 2012; 157(2):878–888.
  11. Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: A systematic review and meta-analysis. JAMA. 2012; 307(18):1959-1969. doi: 10.1001/jama.2012.3507.
  12. Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: Systematic review and meta-analysis. Am J Gastroenterol. 2014; 109(10):1547-1561. doi: 10.1038/ajg.2014.202.
  13. Crohn’s and Colitis Canada. 2018 Impact of Inflammatory Bowel Disease in Canada. 2018. [cited October 2022]. Available form: https://crohnsandcolitis.ca/Crohns_and_Colitis/documents/reports/2018-Impact-Report-LR.pdf
  14. Limketkai BN, Iheozor‐Ejiofor Z, Gjuladin‐Hellon T, et al. Dietary interventions for induction and maintenance of remission in inflammatory bowel disease. Cochrane Database Syst Rev. 2019; 2:CD012839. doi: 10.1002/14651858.CD012839.pub2.
  15. Kafil TS, Nguyen TM, MacDonald JK, et al. Cannabis for the treatment of Crohn's disease. Cochrane Database Syst Rev. 2018; 11:CD012853. doi: 10.1002/14651858.CD012853.pub2.
  16. Friedman S, Blumberg RS. Chapter 295: Inflammatory bowel disease. Harrison’s Principles of Internal Medicine. 18th Edition. The McGraw-Hill Companies, 2012.
  17. Kafil TS, Nguyen TM, MacDonald JK, et al. Cannabis for the treatment of ulcerative colitis. Cochrane Database Syst Rev. 2018; 11:CD012954. doi: 10.1002/14651858.CD012954.pub2.
  18. Lahat A, Lang A, Ben-Horin S. Impact of cannabis treatment on the quality of life, weight and clinical disease activity in inflammatory bowel disease patients: A pilot prospective study. Digestion. 2012; 85(1):1-8. doi: 10.1159/000332079.
  19. Crohn’s and Colitis Canada. 2018 Impact of inflammatory bowel disease in Canada. [Internet] 2018. [cited October 2022]. Available form: https://crohnsandcolitis.ca/Crohns_and_Colitis/documents/reports/2018-Impact-Report-LR.pdf

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