What does it mean when your stomach “growls”?

Stomach "growling" is typically associated with hunger or an absence of food in the stomach.  The medical term for intestinal rumbling is borborygmus (bor-boh-RIG-mus).  If you say this out loud, you may find that pronouncing the word mimics the sound produced when your stomach growls.  In fact, the word borborygmus is an example of onomatopoeia, a word that imitates a sound. It comes from a Greek word that translates as "rumbling".
   
Sounds heard in the abdomen involve activity of the smooth muscle that lines the stomach and small intestine.  This muscle produces peristalsis, a progressive wave of contraction and relaxation that forces food, gas, and liquids through the stomach and intestines.  Peristalsis, like the beating of the heart, is under the control of the autonomic nervous system, occurring on a regular basis without requiring conscious effort.

After eating, peristalsis increases to move food through the digestive tract.  If one hasn't eaten in a while, peristalsis also increases and produces the rumbling noise associated with hunger.  This rumbling is more commonly associated with hunger than satiety because it is louder when the stomach and intestines have no food in them to muffle the sound.  So while stomach growling is most commonly associated with hunger, it can also occur after eating when the stomach is full.  And the sound does not just come from the stomach, but can be generated by the small intestines also.

In some cases, as with viral gastroenteritis ("stomach flu"), the sounds can be accentuated due to an increase in peristalsis. Increased amounts of gas in the intestinal tract may also bring about excessive abdominal rumbling.  One cause for this is lactose intolerance, a condition that occurs when the body does not make enough of an enzyme called lactase. With insufficient lactase in the intestine, lactose sugar, commonly found in dairy products, is instead broken down by gas-producing bacteria in the bowel.

Bowel sounds can be reduced when intestinal peristalsis is slowed down. This could be due to taking an opiate medication, receiving general anesthesia or undergoing bowel surgery.  A more serious situation may exist when bowel sounds stop altogether. This could indicate a problem such as bowel obstruction or an abdominal infection.

In general, the sounds produced in the abdomen, including growling, are not a sign of disease.  Stomach growling may be socially embarrassing, but in most cases is just a sign that the gastrointestinal tract is doing its job.

Sources for article: 
Abdominal sounds from Medline Plus
Why does your stomach growl when you are hungry? from Scientific America
Why does my stomach growl and make noises? from Tufts Now,u

Understanding Fibromyalgia

Fibromyalgia is a chronic medical condition characterized by widespread muscle pain, fatigue, and multiple tender areas known as "trigger points". Fibromyalgia is considered to be an arthritis-related condition, but it is not truly a form of arthritis because it does not affect the joints (knees, shoulders, wrists, etc.) per se.  Nor is it associated with inflammation as in arthritis.  In fact, doctors do not yet know what causes fibromyalgia.  The leading theory is that the pain receptors in the brains of people with this condition are more sensitive to pain signals. Thus, those with fibromyalgia appear to have an exaggerated response to pain. Something that would be only a minor annoyance to someone without this condition could be severely painful to someone with fibromyalgia.  Chronic sleep disturbances, previous injuries, and psychological stress have also been suspected as playing a role in its development.

How it's diagnosed

It is estimated that fibromyalgia affects approximately 5 million Americans. For unknown reasons, between 80 and 90 percent of those diagnosed with fibromyalgia are women. There also seems to be a tendency for fibromyalgia to run in families, although it is not known whether this is due to genetic or to environmental factors. Unlike many illnesses, blood tests, x-rays or special studies are not involved in making the diagnosis. Rather, the diagnosis is "clinical", meaning that there is a group of characteristic signs and symptoms that suggest the diagnosis.  Sometimes, however, tests are important to rule out other illnesses, particularly "rheumatic" diseases such as Lupus and Rheumatoid Arthritis.  Guidelines established by the American College of Rheumatology make the diagnosis likely if someone has widespread pain for at least 3 months with multiple tender areas ("trigger points"). Common manifestations of fibromyalgia include sleep disturbances, fatigue, morning stiffness, headaches, numbness or tingling of the extremities and generalized aches and pain.

How it's treated
There is no cure for fibromyalgia, but symptoms can often be managed with a combination of drug and non-drug treatments.  Three medications, duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica) have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia.   Duloxetine was originally developed for the treatment of depression and is still used for this indication. Milnacipran is similar to another antidepressant medication but is FDA approved only for fibromyalgia.  Pregabalin is a medication that was developed to treat nerve-related pain but works for some with fibromyalgia also.

Over-the-counter pain medicines such as ibuprofen and acetaminophen are commonly used to treat discomfort associated with fibromyalgia.  In general, opioid medications should be avoided by those with this condition. Some patients find benefit from antidepressants, such as fluoxetine (Prozac), which appear to increase the level of certain chemicals in the brain (serotonin and norepinephrine) which are reduced in fibromyalgia. It is generally felt that those with fibromyalgia benefit from physical activity even though this can be difficult at times because of fatigue and body aches.  Group or assisted physical activities such as exercise classes or formal physical therapy may help provide motivation for those with fibromyalgia to become more active.  Many people with fibromyalgia also report varying degrees of success with complementary and alternative therapies, including massage, movement therapies such as Pilates, acupuncture, and various herbs and dietary supplements for different fibromyalgia symptoms.

Long-term outlook
Perhaps the best news for those who suffer with fibromyalgia is that it will not lead to joint degeneration and it is not one that will shorten life expectancy.  The associated depression and physical limitations, however, can be very debilitating.  In many cases the illness seems to just "burn out", whereas others may struggle with this for life. Maintaining a positive attitude also seems to be a key in coping with this condition.

Sources for article:
Fibromyalgia from the American College of Rheumatology
Questions and Answers about Fibromyalgia from the National Institute of Arthritis and Musculoskeletal Diseases

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Do Carbonated Beverages Affect Bone Strength?

Osteoporosis is a disease in which bones lose strength and density. Results of studies have been inconsistent, but some point to soft drink consumption as having a negative effect on bone density.  This has important implications to the more than 10 million Americans, mostly women, who have osteoporosis as well as those who are at risk for osteoporosis. The chief concerns related to soft drinks are that 1) they displace milk in the diet which is a rich source of calcium and 2) some contain phosphoric acid which binds with calcium to impair its absorption.

When taking factors related to calcium metabolism and bone development into consideration (age, calcium intake, exercise, use of tobacco and alcohol, estrogen status, etc.) some studies have found no association between bone density and intake of any type of carbonated beverage.  One study, however, has shown that in teenaged girls, consumption of colas and other carbonated beverages tripled the risk of bone fractures compared to girls who did not drink carbonated beverages.  This is particularly disturbing since adolescence is a crucial time for bone development that provides protection against osteoporosis later in life.
 
One of the largest studies on the subject involved the Framingham cohort, a population of individuals in the Framingham, Massachusetts area who have served as subjects for a number of long-term studies. Findings from this study indicated that in women, but not in men, consumption of more than three servings of cola per day resulted in significantly lower bone density readings as compared to those women who drank only one serving per day. Non-cola beverages, on the other hand did not seem to affect bone density in women or men. The postulated reason for this is that the phosphoric acid in cola beverages negatively affected calcium absorption.  These results suggest that cola, but not other carbonated soft drink consumption, contributes to lower bone density in adult women.

Once established, osteoporosis can be difficult to impossible to reverse. This is why it is so important to take steps to prevent its development in the first place.  Measures that help maintain bone health include getting the recommended amounts of calcium and vitamin D each day.  Dietary intake of calcium can be increased by eating more dairy products, fish, such as canned salmon and sardines, dark green leafy vegetables and calcium fortified orange juice.  Also, engaging in regular weight-bearing exercise and avoiding smoking or drinking excessive amounts of alcohol are correlated with improved bone health. Along with these measures, the National Osteoporosis Foundation advises that people with osteoporosis should not drink more than five cola drinks a week.

Sources for article:

Teenaged girls, carbonated beverage consumption, and bone fractures from the Archives Pediatric Adolescent Medicine

Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study from the American Journal of Clinical Nutrition

Frequently Asked Questions regarding Osteoporosis from the National Osteoporosis Foundation

Eating to Fight Fatigue

Fatigue is defined as a feeling of weariness, tiredness, or lack of energy.  There are a number of conditions that can lead to fatigue including anemia, depression, thyroid disease, and diabetes.  Many people reporting temporary or recurrent fatigue, however, are tired because of three factors---inadequate sleep, poor nutrition or excessive stress.  In today's Health Tip, we'll look at some of the nutritional measures that can help reduce fatigue and improve energy levels.

Eat breakfast.  The brain uses glucose as its primary source of fuel.  For most people, up to 12 hours passes from the evening meal until morning, with most of the body's available glucose being depleted.   Breakfast refills our tank and provides a readily available energy source. Studies have shown that people who eat breakfast on a regular basis have improved concentration, problem solving ability, mental performance, memory, and mood.  In fact, many nutritionists consider breakfast to be the most important meal of the day.

Watch your caffeine intake.  Caffeinated beverages (coffee, tea, etc.)  are commonly consumed in the morning to provide a "jump start" to the day. Caffeine in moderation not only makes us feel more energized, it has also been shown to increase alertness, reaction speed and ability to think clearly. Too much coffee, however, can make us irritable and jittery.  Drinking caffeine late in the day can be a bad idea since it can disturb our sleep patterns and lead to fatigue the next day.

Keep well hydrated.  Water is the body's principle chemical component with up to 60% of body weight being comprised of water. The brain itself is almost 70% water!  Water in the blood stream is responsible for carrying nutrients to the cells and removing waste.  Fatigue can be one of the first signs that the body is dehydrated. The Institute of Medicine advises that men consume roughly 3 liters (about 13 cups) of fluid a day and women consume at least 2.2 liters (about 9 cups) of fluid a day.  Another way of gauging your hydration status is to monitor your urine output. When well hydrated, most people will need to urinate every two to four hours with the urine being clear or pale yellow in color.

Eat small, frequent meals.  Eating "3 squares a day" may not be the best way for everyone to address caloric needs throughout the course of a day. Not only does the metabolic requirement of digesting a large meal lead to lethargy, many people have a "sinking spell" between meals resulting in eating even more between meals.  A better way of fueling the body may by eating smaller meals or a snack at approximately four hour intervals.  This approach provides the brain with a steady supply of nutrients and helps prevent the onset of fatigue.

Moderate alcohol consumption.   As a sedative, alcohol has an obvious deleterious effect on one's energy level.   A large lunch along with an alcoholic beverage can set the stage for an unanticipated afternoon nap.  Drinking shortly after work can adversely affect one's energy level in pursuing a hobby or spending time with the family later in the evening.  Drinking excessively or close to bedtime may facilitate falling asleep, but the quality of sleep is usually not optimal, leading to fatigue the next day.

 Eat carbohydrates with a low glycemic index.   The glycemic index ranks carbohydrates as to how quickly they raise blood glucose.  Foods with a high glycemic index (white bread, refined cereals with sugar, instant oatmeal, soda, and candy) raise blood sugar quickly.  While these may produce a temporary burst of energy, the resultant insulin surge is then followed by a plunging glucose level. This can lead to fatigue as well as to symptoms of hypoglycemia. Eating foods with a low glycemic index (most fruit and vegetables, whole grain breads, pasta, milk, yogurt, cheese, soybeans, etc.) helps to moderate swings in blood sugar.

A word on "energy boosters".  Any number of vitamins, herbs, and nutritional supplements make the claim to be able to boost energy.  These include guarana, found in many energy drinks, as well as ginseng, vitamin B12, and coenzyme Q10.  There is very little evidence, however, to support the use of any of these as energy boosters. Many of these products have marketed themselves as "nutritional supplements" in order to avoid having to prove most of their claims.

Along with these nutritional tips, getting regular exercise and managing life stresses are other important measures for improving energy levels.  Unrelenting exhaustion, particularly if there is no improvement after following healthy life-style measures, could be due to an underlying psychological or physical disorder that warrants medical evaluation.

Sources for Article:
The Energy Diet from the National Health Service
Fatigue from Medline Plus
Top 10 Ways to Boost Your Energy from WebMD