What is FD?

FD (recurring indigestion) is typically meal-triggered and is a relatively common and often frustrating condition. About one in six Americans have Functional Dyspepsia1-3. FD is often described as non-ulcer dyspepsia. FD is an under-diagnosed4 and under-managed condition. FD is a disorder of sensation and movement in the organs of the upper digestive tract where the normal downward pumping and squeezing is altered. The intake and uptake (i.e. digestion and absorption) of food nutrients, can be affected.

What Causes FD?

In the absence of a known organic cause, it is thought that FD is associated with the disruption in the lining of the gut (gut mucosal barrier) and reversible, localized, often temporary, low-grade immune activation, which can result in the impaired ability to digest and absorb food nutrients5-7. Common triggers are food8, stress9, and the environment10. Food sensitivities, in particular, are commonly associated with FD8. If FD is suspected, consult with a physician about confirming FD and then developing a program to manage it.


What Are The Symptoms of FD?

In addition to impacting the intake and uptake (i.e. the digestion and absorption) of food nutrients, the symptoms of FD are in the upper belly and include, at varying times, and at varying intensities, some or all of the following:

  • Abdominal pain or discomfort or cramping
  • Difficulty finishing a meal
  • Bloating
  • Nausea

Where do the Symptoms of FD Occur in the Digestive System?

FD occurs in the upper belly, above the navel. In FD, the stomach does not expand normally in response to a meal which means the food eaten backs up in the stomach and in the upper part of the small intestine.

Dietary Modifications

Physicians often recommend gradually increasing fiber intake, starting with 2-3 grams per day. Physicians may also recommend exclusionary diets11. Also, NSAIDs are discouraged by physicians. Diet alone may not be practicable in managing FD, but should be part of your overall FD program, implemented with a physician.

Stress Management

Physicians may recommend common stress management tools including regular exercise, taking time to relax, and getting an adequate amount of sleep every night.



Unfortunately, no Rx drugs are approved for FD. Physicians may either prescribe Rx medications off-label or recommend non-prescription products, to manage FD.


Even before the introduction in 2016 of the improved formulation using SST (Site-Specific Targeting) technology which is in FDgard, the combination of caraway oil and peppermint oil (primary component: l-Menthol) had been shown in several randomized, placebo-controlled studies to be effective in the management of FD.12

Physicians now increasingly recommend FDgard, a medical food specially formulated for the dietary management of FD. FDgard capsules contain solid-state, triple-coated microspheres of caraway oil and l-Menthol, along with fiber and amino acids (from gelatin protein). Common triggers of FD are food8, stress9, and the environment10. Food sensitivities, in particular, are commonly associated with FD8. That's why physicians are now recommending taking FDgard 30 to 60 minutes prior to a meal. FDgard has been shown in a peer-reviewed and published medical journal and in peer-reviewed presentations to be effective in managing FD symptoms§.

Physicians also recommend, in the case that a pre-meal dose is missed, FDgard can also be taken with or after a meal.

People with FD often do not eat regularly or normally, which may affect their normal intake of nutrients. Also, the uptake (i.e. the digestion of food and the absorption) of nutrients is affected due to disturbances in the GI tract. Vitamin B12 and folate deficiencies are examples of nutritional deficiencies that have been observed in the FD population13.

There is increasing evidence that impaired mucosal defense mechanisms are implicated in the pathogenesis of Functional Gastrointestinal Disorders (FGIDs), including the two most common FGIDs, IBS and FD, allowing immune activation. Specifically, perturbations of GI microbiota, altered mucosal permeability, and abnormal mucosal defense mechanisms have been implicated in the pathogenesis of some FGIDs14-21.

Over 90% of nutrient digestion and absorption takes place in the small intestine22. With FD, this digestive and absorptive process is disrupted in several ways. The bile acid flow is disrupted as part of the cascade of disruption in FGIDs23. Peppermint oil (primary component: l-Menthol) helps restore secretory function such as bile flow24. The German Commission E monograph for peppermint oil lists its use as an anti-spasmodic for bile ducts25. This and other known activities of peppermint oil are helpful in digestion and absorption. The additional anti-spasmodic ingredient, caraway oil, plays an important complementary role in the management of FD8.


Dietary modification alone, as a management strategy, has had mixed success especially with long-term adherence. Exclusionary diets11 that exclude pro-inflammatory foods such as french fries, sugary sodas, refined carbohydrates and certain fried foods, may help in the short term but also may lead to nutritional imbalances and adherence issues in the long-term. Fiber and relaxation techniques can be helpful, but may not be enough.

Now doctors increasingly use medical foods, such as FDgard, to help normalize the intake and uptake (i.e. the digestion and absorption) of food nutrients, and to help manage FD symptoms.

FDgard is specifically formulated to meet the distinctive nutritional requirements of FD that cannot be met with dietary modification alone. FDgard is designed to supply specially processed, solid-state microspheres of caraway oil and l-Menthol, which help enable proper digestion of food and enhanced absorption of nutrients and to help manage the symptoms of FD. By supporting gut health in the first place, FDgard may help avoid nutritional issues downstream.


The PreMeal Companion®