Feeling full
Dear Lucy: My stomach feels full and bloated all the time, whether I've eaten or not. Do you know why?—All Puffed Up

Dear Puffy: Lucy knows how awful bloating can be. Clothes don't fit right, food doesn't sit right, and your day feels all off. For help in answering your question, Lucy turned to MIT Medical gastroenterologist Richard Gardner, M.D.

Gardner tells Lucy that frequent feelings of bloating and abdominal distention with stomach cramps can be symptoms of a "functional bowel disorder" (FBD). This term encompasses a group of gastrointestinal disorders, including bowel irregularities (constipation, diarrhea, or a combination of both), abdominal pain, or irritable bowel syndrome (prolonged bouts of chronic abdominal pain, disturbed bowel function, and bloating). Stress can cause intestinal muscle spasms, making symptoms worse.

A bloated feeling persisting more than a few days may indicate a more serious intestinal problem. Gardner suggests a visit to your primary care clinician, who may refer you to a GI specialist if further evaluation is needed.—Lucy

Got calcium?
Dear Lucy: What happens if we take too much calcium (More than 100 percent of the recommended daily allowance) for an extended period of time? Although it is unlikely I take too much calcium, I was wondering if taking too much would cause any harm.—The More The Merrier?

Dear TM2: Lucy applauds your caution. Too often, people think, "If a little is good, a lot is better." This is not always true, especially when it comes to what we put into our bodies. Lucy asked MIT Medical nutritionist Anna Jasonides, R.D., and endocrinologist William Kettyle, M.D. for help with your question.

These experts tell Lucy that the most common risk of taking too much calcium over an extended period is hypercalciuria, or excess calcium in the urine. For individuals with a personal or family history of kidney stones, hypercalciuria raises the risk of kidney stone formation.

Drug and nutrient interactions may also be a problem. Calcium can decrease the effectiveness of several antibiotics, as well as some common medications for cardiac or thyroid conditions. It can also decrease the absorption of other nutrients, including iron and zinc, and may affect vitamin K metabolism.

It's also important to make sure you are not getting too much vitamin D, which is often included in calcium supplements. Excess doses of many water-soluble vitamins pass right thru the body, but fat-soluble vitamins like A, D, E, and K can accumulate. Excess vitamin D leads to increased calcium absorption. The combination of excess vitamin D and excess calcium can cause major problems involving too much calcium in both urine and blood.

The maximum daily calcium intakes recommended by the National Institutes of Health are:

• adolescents (11-24 years), 1200 mg.
• adults 25-50 years, 1000 mg.
• females over 50 years not taking estrogen, 1500 mg.
• females over 50 years taking estrogen, 1000 mg.
• men over 50 years, 1500 mg.

As always, your best bet is to consult with a clinician regarding your own specific needs.—Lucy

Concerned about nonoxynol-9
Dear Lucy: I have heard that the use of condoms with nonoxynol-9 can cause the vaginal walls to become more porous and, therefore, more susceptible to STD (sexually transmitted disease) transmission. Is this true? Is there a substitute for nonoxynol-9 that doesn't have adverse effects?—Condom Concerns

Dear CC: Nonoxynol-9, a spermicidal agent, is the active ingredient in most contraceptive creams, gels, suppositories, foams, films, and sponges. It is also an ingredient in some condom lubricants. Unfortunately, nonoxynol-9 exposure can cause irritation to the vaginal wall. However, vaginal irritation associated with condom use could be due to latex allergy instead. In either case, MIT Medical internist Howard Heller, M.D., an expert on STDs, confirms that such inflammation can, indeed, increase the transmission risk for some STDs.

Vaginal inflammation usually produces symptoms like burning, itching, or discharge. Inflammation can also be seen during a pelvic exam, which means it can be diagnosed visually, even if there are no symptoms.

If nonoxynol-9 is a problem, a different type of contraception should be used. Condoms should still be used to prevent STD transmission. Polyurethane condoms are available for people with latex allergies.

As always, MIT Medical's OB/Gyn Service (617/ 253-1315) and Health Education (617/ 253-1316) are excellent resources for additional information.—Lucy