Dealing with Common Pregnancy Woes Like Constipation, Heartburn and Gas

An unfortunate (and oh-so-not-cute) side effect of pregnancy is what happens to your digestive system. Depending on how far along you are, you've probably been experiencing everything from constipation (and possibly hemorrhoids as a result) to uncontrollable gas. One reason: Your system is slowing down, thanks to rising levels of progesterone, and with your ever expanding uterus, there's increasingly little room for food to go and for digestion to take place. Plus, those meddling hormones continue to wreak all sorts of havoc. Here's the gamut of gastrointestinal (GI) disturbances, and how to deal with them.

Heartburn

I always thought that heartburn was something only chili dog-eating truckers got. Boy, was I dumb. Those increased levels of progesterone (which the placenta is churning out in large quantities) in your body cause your esophageal sphincter to become more relaxed. Though it sounds like something that would be close to your tush, the sphincter is actually the little valve that covers up your esophagus and normally keeps all that stomach acid from irritating your throat. When it relaxes, it allows the acid to splash up into your throat, causing heartburn. Heartburn usually shows up during the third trimester, when the baby really starts taking over your body's real estate, and the esophageal valve is physically pushed up. But some women are hit with the burn in their first trimester, like my friend Laura during her second pregnancy. She found relief by laying off the offending foods below (even though they're what she craved most). Some pregnant women get heartburn just from drinking water. Oy vey.

Tips on avoiding the burn:

• Lay off spicy foods.

• Try not to eat a large meal right before going to bed (no later than two hours before bedtime).

• Prop yourself up on pillows while sleeping to keep everything in its proper place.

• Avoid coffee and soda-they often make symptoms worse. The same goes for chocolate.

• If you find that tomato-based sauces, such as marinara, give you heartburn, try going with pesto.

• Avoid taking iron supplements at night. They tend to cause heartburn.

• Milk and other dairy products help coat the throat and stomach and might soothe irritation.

• Antacids, such as Tums, Rolaids, Mylanta, and Maalox, can help, but make sure to check with your doctor before taking them.

Gas

Oh, joy, as if the bloated ankles, the loss of your waistline, and the inability to stay up past 8:30 weren't enough, you've become a total windbag. Again, blame it on the hormones and the lack of room in your belly. Fine, but at least before you were preggers you usually had the ability to hold in your farts, at least for a while. Now you worry that someone behind you with a lighter might cause significant harm to you or others. Can anything be done to stifle the buildup?

• Avoid the foods that make it worse. If cabbage and other cruciferous veggies (Brussels sprouts, broccoli, cauliflower) make your belly expand, you can either avoid them, deal with the consequences (because they're super-healthy), or cook the crunch out of them. Raw veggies of all stripes might cause gas. Beans are pretty much guaranteed to give you gas, no matter what. Soybeans and soy-based foods are part of the gas brigade as well.

• Eating gas-causing foods won't physically hurt you or your baby, but it's sure to come back and bite you in the ass. It can also cause painful cramps. Taking Beano when you eat veggies and beans can help cut down on gas. It's generally considered safe to use during pregnancy, but check with your doctor before taking it.

• Dried and fresh fruits can make you gassy, but they also help prevent constipation, so it's a classic Catch-22.

• Dairy might also be the culprit. Sometimes pregnancy makes it easier for you to digest milk, yogurt, and other cow's milk products, and sometimes it makes it worse. In general, the good bacteria found in yogurt and other cultured dairy will help regulate your digestion and cut down on gas and bloating.

• Onions and garlic can make you gassy-especially when they're raw. So stick to cooked and try to keep your portions of super-oniony foods small.

• Gulping air while eating can trap gas, causing burps and farts. So do what Mom told you and keep your trap shut while you're chewing. Even though they're fun, avoid drinking through straws, because you'll end up swallowing more air. Chewing gum can also trap gas.

• Almonds and other nuts can make you gassy. Try sticking to a ¼-cup serving size-about twenty-four almonds or fourteen walnut halves-and see if that helps.

• Cut the high fiber. High-fiber cereals are great for packing in fiber, but if you're not used to getting 10 g in a single bowl, they can turn you into a high priestess of cutting the cheese. Try mixing your super-fibrous cereal with another that just has a few grams. Over a month or so, you may be able to work your way up to eating an entire bowl of the high-fiber stuff without the obnoxious effects.

If all else fails, pull on some comfy sweats and take a walk around the block with the dog. Not only will she not mind if you're a little stinky, but it's also a great way to get things moving...and as my grandmother Selma always said, "It's better out than in."

Constipation and Hemorrhoids

So what more can pesky progesterone do? Lots. Just as it relaxes your esophageal sphincter, it also slows down your digestive system. Food usually gets moved along through the intestines with muscular contractions, but progesterone can slow it down, causing constipation. Becoming dehydrated contributes to constipation, because your large intestine will take whatever water it can get from the food you eat, leaving you with rock-hard excrement that can be very painful to pass. What fun!

Since your system is slowing down and there's added pressure from the weight of your growing uterus, you're probably struggling when you have to poo. Hemorrhoids-well, they're like constipation's evil sidekick. They're actually always around-but when there's additional pressure on your booty canal, the veins in the hemorrhoids can swell and sometimes even burst. Hemorrhoids can develop both internally and externally.

Can you do anything to prevent the 'roids? Absolutely-drink a heck of a lot of water, avoid straining on the toilet, exercise regularly, and get 28 to 30 g of fiber a day. How can you pack that much into a day?

Try getting several of these fiber-rich foods daily:

1 cup blueberries (fresh or frozen) 4 g

1 cup cooked black beans 15 g

1 cup garbanzo beans (chick peas) 11 g

1 ounce almonds 17 g

1 large apple 5 g

1 large pear 7 g

5 prunes 3 g

6 ounces prune juice 2 g

1 cup Kashi GoLean cereal 10 g

½ cup Kellogg's All-Bran Original 10 g

1 Kellogg's All-Bran Bar 5 g

1 cup cooked whole-wheat pasta 6 g

1 cup cooked brown rice 4 g

And yes, there are two types of fiber-soluble and insoluble. The first type, which helps lower cholesterol and blood sugar, is found in oats, peas, beans, apples, citrus fruits, barley, and psyllium. Insoluble fiber is like hay-it doesn't dissolve in water and helps give you a really full feeling, plus it helps you have bowel movements. It's found in whole wheat, bran, nuts, and vegetables. Instead of thinking too much about which type of fiber you're getting, just know that getting both types will help you stay healthy.

Bloating and Swelling

If you're in your seventh month and you can still wear your wedding ring, you're a rock star. Most women are guaranteed to swell up at some point in their pregnancy, especially toward the end. Ankles, calves, hands, and feet are all fair game, but if your face is swelling, you may have preeclampsia. Call your doctor if both your face and hands become swollen. Since caffeine is out, you can't turn to that old diuretic staple for help, but there are things you can do to help you feel like less of a water balloon.

Certain foods contain natural diuretic properties. Asparagus is one of them, and it also happens to be rich in folic acid, so it's doubly good for you right now. Celery does the trick, too, so it makes sense to snack on this low-cal cruncher. Other foods that don't necessarily stimulate the production of urine, but are rich in water, include watermelon (duh), honeydew melon, cantaloupe, and cucumber. It might seem counterintuitive, but drinking water and eating fluid-rich foods can help ease swelling.

Avoiding sodium will also help you beat the bloat. When you've had too much sodium-rich food, your body retains water to try to keep the sodium levels in your body fluids balanced. Drinking more water will help you flush that excess salt out of your system. Eating foods rich in potassium, such as bananas, potatoes, avocado, and cantaloupe, will also help you beat the bloat.

While we do need a certain amount of salt each day, most of us get way too much. Here are some tips for cutting out excess salt:

• Step away from the shaker. If you're one of those people who salts her food before she eats, try to kick the habit. Take a couple of bites first, and if it's still bland, add a judicious shake or two.

• Rinse cycle. When using canned beans and veggies, rinse them first in a colander. You'll reduce the sodium considerably. As you rinse those beans, you'll also be washing away a lot of their gas- producing polyscaccharides.

• Get fresh. Processed foods are high in sodium because it makes food taste good and acts as a natural preservative. If you're eating primarily fresh foods, you're naturally cutting back on sodium (but that's not necessarily true for restaurant food).

Probiotics have been a big buzzword the last few years. These beneficial bacteria-aka live active cultures, like lactobacillus acidophilus-can do you a world of good digestion-wise and also help guard against nasty yeast infections. Yeast infections are more common during pregnancy because vaginal secretions increase in sugar, which provides lots of energy for yeast to feed on. Remember, you can't just pop a Diflucan (a common drug for yeast infections) when you're pregnant, because that medication isn't approved for use by pregnant women. I know, it's a totally gross and uncomfortable situation, but you can fight back against the yeasties with your own army of good bacteria.

What's the magic in the microbes? Beneficial bacteria help break down food, making digestion easier. They also help fight bad bacteria in your gut and restore balance to your intestinal microflora. It's kind of like feng shui for your belly. Benefits of eating food with probiotics include reduced bloating and indigestion.

Where to get probiotics:

• Yogurt. Go for plain and look for sweetened varieties made with less sugar (but not the sugar-free kind)-no more than 20 g of sugar per serving. Often, the kinds with fruit on the bottom have more sugar than the blended style. Greek-style yogurt has become really popular and more widely available in the last few years. It's rich and creamy because it's triple strained; even the fat-free stuff is nice and thick, and it's higher in protein.

• Digestive drinks, yogurts, and probiotic smoothies. These yogurts and drinks, such as Activia, Yo-Plus, and GoodBelly (a great non-dairy option), use specific strains of probiotics to help ease digestive woes and often contain prebiotics as well (read on to find out more about them). However, you usually have to eat or drink them consistently for at least two weeks to see a benefit.

• Kefir. This tangy drink is like a cross between butter milk and yogurt. If you don't like the flavor on its own, try it over cereal or as a base for fruit smoothies.

• Cottage cheese. Some brands, such as Nancy's and Kraft's Live-Active, include live active cultures. I know cottage cheese screams "diet plate at the assisted living center!" but it's really quite nice mixed with berries or spread on a piece of hearty toasted bread and topped with tomatoes, salt, and pepper.

So you know where to get the good bugs, but to make them work even better, make sure to get prebiotics too. Probiotics rely on prebiotics for food, so it's important to get both at the same time for the biggest benefit. Fructan and inulin are prebiotics that are added to several brands of yogurt and probiotic drinks. Prebiotics also occur naturally in foods like artichokes, asparagus, green beans, leeks, onions, barley, and wheat.

You don't need to turn this into a science project and start dousing your green beans in strawberry yogurt, but try to fit in one food with good bacteria each day-preferably one with a prebiotic-and you're likely to see the benefits. Also, keeping your sugar intake under control will help keep your intestinal flora balanced, which adds up to better digestion and fewer yeast infections.

Notes:

American Pregnancy Association Fact Sheet on Heartburn. www.americanpregnancy. org/pregnancyhealth/heartburn.html.

Merck Manual of Women's and Men's Health, p. 278.

American College of Obstetricians and Gynecologists Patient Pamphlet on High Blood Pressure During Pregnancy. www.acog.org/publications/patient_education/ bp034.cfm.