9 Tips for Managing Gastrointestinal Side Effects

Patient Expert

Many RA meds have one side effect in common: they can make your gastrointestinal system very unhappy. Acid reflux or GERD can make it feel as if there's a roiling vat of acid burning up your midregion. Then there's nausea, bloating, gas and constipation or diarrhea that can feel very similar to Irritable Bowel Syndrome (IBS). Speak to your doctor about your symptoms. If they seem to be side effects of your medications, most of the time, it's possible to find a way to manage them.

1. Acidophilus or probiotic. Probiotics are a type of live microorganisms that can help to balance the natural bacteria in your gut. As they do, they may also balance the functioning of your bowels, addressing both constipation and diarrhea. In my experience, they can also work wonders in reducing acid. My naturopath recommended that I buy the good stuff from the health food store, keep it in the fridge and take one or two doses a day with meals. The only "side effect" can be loose stools if you're taking too much. If that happens, reduce the dose and you should be okay.

2. Ginger. Ginger can be a wonderful aid to help control nausea. In fact, a recent study showed that it could significantly reduce chemotherapy-related nausea in cancer patients. Buy fresh ginger in the grocery store, cut a piece and peel it. Slice or grate the ginger and add it to dishes such as stirfries for a wonderful flavor. Placing a small piece about the size of a nickel in hot water can make a soothing drink. Add a squeeze of lemon or a bit of honey depending on your preference. You can also buy ginger root supplements. As is always the case with supplements, talk to your doctor before you start taking anything new.

3. Hot Drinks and teas. Caffeinated beverages, such as coffee and tea, can be hard on an upset stomach. Instead, try herbal varieties, such as peppermint, and (again) ginger teas. Years ago, my shiatsu therapist told me about hot water with a small slice of lemon - oddly enough, it can work miracles on acidic stomachs. It can also be very soothing if your stomach is upset. Cut a fairly thin slice of lemon into four pieces. Add one of these quarter pieces to a cup of boiling water. If it tastes sour, the piece of lemon is too big.

4. Eat. Eating is the last thing you want to do when you stomach is upset, but it can help keep the acid down to a dull roar. If your stomach is empty, you're going to feel the symptoms of acid even more. Avoids foods that can trigger acid reflux and stick to mild, blind foods such as steamed chicken and fish, rice, bread and crackers.

5. Eat specific foods. If your medication make you constipated, including high-fiber foods in your diet can help you get more regular. Eat lots of fruits and vegetables, choose high grain breads instead of white, learned to love high-fiber cereals (many of them are very tasty) and snack on trail mix instead of cookies. If you get diarrhea, stay away from high-fiber foods until it's resolved. Certain foods such as nuts, beef, blueberries and white rice can make you constipated, so they might help.

6. Over-the-counter Medication. If you walk down the aisle in your drugstore marked "Stomach Remedies," you'll see that you're not alone. Based on the number of choices for various over-the-counter stomach remedies, many people are in a similar situation. Dramamine is an excellent antinausea medication, but can make you drowsy so don't take it if you have to operate heavy machinery or drive your car. Certain over-the-counter medications can block the production of stomach acid. They include Prilosec OTC (a Proton Pump Inhibitor) and Zantac. Talk to your doctor about what will be the best choice for you. For occasional relief of acid reflux, heartburn and indigestion, use antacids such as Gaviscon, Maalox and TUMS. If you have a lot of gas and bloating, Gas-X and Beano can help you control symptoms. If you get diarrhea, Imodium can help stop it, although if your diarrhea continues for more than a day or two and your health is affected by it, you may want to discuss the situation with your doctor

7. Prescription Medication. Over-the-counter medications that block the production of stomach acid are for milder cases. If you have more severe symptoms that cannot be managed with over-the-counter medication or the other tips in this article, talk to your doctor about prescription drugs. PPIs such as Nexium, prescription Prilosec and Pantoloc can be very useful to manage these types of symptoms.

8. Stress Management. When you're under stress, it releases a variety of hormones and immune system proteins in your body. This physiological response can have a real impact not just on your emotional well-being, but your physical health, as well. A number of physical symptoms can be triggered by stress, including stomach upset and diarrhea. Finding a way to manage - or even reduce - stress may help calm down your stomach. Simple breathing exercises can reduce stress in the moment. As well, yoga and meditation may help reduce overall stress. As an additional benefit, yoga can help you manage chronic pain and with some modifications can be practiced by most people who have RA. It's always a good idea to talk to your rheumatologist before you start a new exercise program to make sure you know how to protect your joints.

9. Know Your Limits. A big part of managing side effects is knowing when enough is enough. Your medication is supposed to help you live a better life. If side effects end up significantly affecting your quality of life, it may be time to talk to your doctor about treatment options.

Lene is the author of the award-winning blog The Seated View.