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Heartburn or Prediabetes, Which Leads to Esophageal Cancer?
There are times when it seems like every other patient coming into my office is on some type of acid blocker drug to treat their ulcer or heartburn. Most have the mistaken belief that they make too much stomach acid. Consider this: stress lowers stomach acid production and stomach acid production drops as we get older. With these two factors alone, do you think there is anyone who makes too MUCH stomach acid these days?
The easy answer is no. However, if someone has a bleeding ulcer, blocking the acid production will likely save his or her life. Every other case is likely to do much more harm than good. The list of problems associated with acid blocking drugs is quite long. This should come as no surprise given that stomach acid is absolutely essential for a large number of critical processes in the human body (digestion, activation of other enzymes, sterilization of bacteria, activation of the pancreas, absorption of certain nutrients, activation of anti-cancer compounds, etc…).
The list includes:
- Supression in preganancy may lead to asthma in the child
- Acid suppression may increase the risk of esophageal cancer
- Promotion of bone loss
- Promote small bowel bacterial overgrowth due to the survival of bacteria that should’ve been destroyed
The recommendation for acid blocker drugs in many times goes beyond symptom relief and more into the mistaken belief that acid blocking drugs will prevent the progression to Barrett’s esophagus and then to esophageal cancer. As you can see from the study above, the opposite is true. These drugs may actually increase the risk for the condition many doctors are trying to prevent.
This particular article adds weight to this, suggesting that prediabetes is as great of a risk factor, if not greater, for the development of Barrett’s esophagus than is reflux. In some cases quadrupling the risk. This means that the approach to managing any type of gastric issue, whether reflux, ulcer or gastritis needs to involve the whole spectrum of lifestyle changes to head the patient away from diabetes. Shocking to hear me say this, but true.
The other thing to consider is that, most often, patients with heartburn actually make too LITTLE stomach acid. Supporting digestion, using probiotics and improving the diet can go av very long way towards getting rid of reflux for good.
NSAIDS CAUSE ULCERS…HOW??
It comes as a surprise to every patient I bring this up to that non-steroidal anti-inflammatory drugs (NSAIDs) cause anywhere from 16,000-22,000 deaths per year from bleeding ulcers alone.
I usually give this statistic when someone may be nervous about chiropractic care or the safety of chiropractic care. It’s basically the same equivalent as being nervous about flying on a commercial jet under the eyes of the FAA but being OK with bungee jumping off a water tower in Alabama.
These numbers also do not include the monstrous numbers of death caused by NSAIDs’ increased risks of heart attacks, strokes, liver failure and kidney failure. I’m pretty sure most would be absolutely shocked to learn just how dangerous popping a simple over the counter ibuprofen actually is. While these less popular dangerous side effects of NSAIDs are by far more common, the fact remains that most doctors think about the gastrointestinal side effects of NSAIDs more than the other effects.
This is the reason for the creation of the blockbuster class of drugs called the selective COX-2 inhibitors (Vioxx, Celebrex, Bextra). They were supposed to protect the stomach but still achieve the anti-inflammatory effect. So long as you still have your mid-term memory intake, you should remember just how well THAT turned out. For those of you showing early signs of lifestyle-related dementia, Vioxx made headlines and was taken to task by the FDA when it was discovered that they knew that Vioxx was causing heart attacks but downplayed the data from doctors, ultimately leading to Vioxx being pulled off the market.
The ironic part is that, this “GI-protective class” of anti-inflammatories doesn’t even do that very well. Regardless, NSAIDs have known gastrointestinal toxicity. This particular study plants the ultimately irony on this sometimes fatal scenario.
Researchers looked at what might be causing the damage to the lining of the stomach and leading to bleeding ulcers. Their finding? Inflammation.
Yes, the anti-inflammatories are creating their most notorious side effect by the very same mechanism that they are supposed to be stopping. The inflammation in this study came from a compound called TNF-alpha, which is a major driver of inflammation in the body (and the main target of high powered drugs for autoimmune conditions like rheumatoid arthritis and Crohn’s disease).
While this is an animal study, the authors suggest that blocking TNF-alpha with more powerful anti-inflammatories may help protect against the GI related toxicity of the NSAID class of drugs. Brilliant. No wonder our healthcare system is so screwed up.
ARE WE OVERPRESCRIBING ANTIREFLUX MEDICATIONS FOR INFANTS WITH REGURGITATION? – (04-28-08)
Are We Overprescribing Antireflux Medications for Infants With Regurgitation?
I still remember vividly the first time I had a patient come in and say their newborn was place on acid suppressive therapy for reflux. I was dumbfounded. I knew pediatricians have a tendency to be a little off when it comes to medical research, but suppress a normal function as vital as digestion in an infant is just unthinkable. Or at least it was then…now, it seems like every body knows someone who’s baby is on this stuff. The real kicker is that any spitting up is likely going to be related to food allergies, and NOT “too much acid.”
The dangers of NOT addressing the cause of the problems coupled with the dangers of suppressing a natural antibiotic like stomach acid are many. Thankfully, I’m not the only one who’s noticed. These authors ran a study looking at acidity in a group of infants on acid suppressive therapy and found that only 8 of 44 infants actually met the criteria for acid reflux.
ACID BLOCKERS ACTUALLY PROMOTE ESOPHAGEAL CANCER?
ACID BLOCKERS ACTUALLY PROMOTE ESOPHAGEAL CANCER? Shocking thought, huh? The long term use of acid suppressive therapy for GI complaints is something I have a major, major issue with. If someone has a bleeding ulcer, this class of drugs will likely save their lives (of course, the bleeding ulcer is likely cause by yet another class of drugs–NSAIDs!).
Short of this, long term acid suppression opens up a Pandora’s box of epic physiologic proportions. Of course, the reasoning behind the use of these drugs for reflux is to protect the esophagus from developing Barrett’s esophagus and cancer. So why is there concern that they may actually increase the risk? Because of the body’s attempt to fix the problem created by the drugs.
Listen–digestion is one of the most important functions our bodies perform. Blocking this process indefinitely affects nutrient absorption, risk of certain cancers (breast, colon come to mind), risk of infection, functional bowel disorders, allergies, skin problems…the list is quite long.
Bottom line is that we need to support digestion, NOT shut it down. This means managing stress (the KEY component to most cases of reflux), digestive support, probiotics and high intakes of cabbage if severe. Even if this is not successful, this is one of the few times I become a strong proponent of surgery to fix the lower esophageal sphincter so you can come off this class of drugs.
COULD THIS BE CAUSING YOUR DENTAL PROBLEMS?
It is now well established that good oral health is absolutely essential for good overall health. The links between gum disease and heart disease are well established. Looking at it in reverse, what health problems can lead to poor dental health?
Reflux, heartburn, gastro-esophageal reflux disorder (GERD). It goes by many names. The symptoms can sometimes not be as noticeable as simple heartburn. Coughing and difficulty swallowing are also symptoms of GERD. What about dental erosions?
The answer is yes–GERD can be associated with dental erosions. The problem here is that your PCP and your dentist likely don’t chat together very often, so the two conditions may not be linked by the providers.
So the real issue here is not that reflux can cause dental erosions, but rather, what do we do to improve GERD?
If someone is close to dying from a bleeding ulcer, than no one has a good argument that acid suppressive therapy like Aciphex, Nexium or Prilosec is not a good idea. Since this is not usually the case, the use of long term acid suppression is probably one of the worst things a doctor can do for their patients. It is not uncommon for a new patient to come into my office and we find that they have been on medications for this for 10+ years.
What this does to our digestion, especially over these time frames, is incalculable. The list of problems is extensive, but can include obesity, bone fractures, liver problems, allergies, colorectal cancer and depression. For those that think this list is a bit of a stretch–it’s time to read up more on the physiology of the gut and how integral healthy digestion is to this process.
So, here are things you can do to help your stomach and esophagus:
- Chew your food. Saliva helps convert nitrates in fruits and veggies into NO, which has been shown to help support the lining of the stomach.
- Maintain an anti-diabetic lifestyle. Yes, Virginia, diabetes is linked to GERD as well.
- Eat more phytonutrient rich spices, fruits and vegetables. These will protect against oxidative stress. Oxidative stress is a bigger player in reflux than even acid.
- Add digestive support. It is far more common for someone to make too little stomach acid due to stress or aging than for someone to be making too much acid. Supporting digestion can reduce the buildup of gases during the digestive process and lower the risk of forcing open the lower esophageal sphincter.
- If all else fails, non-invasive surgery is likely a better option then stayed on acid suppressive medications for a lifetime.
So, overall, good oral health AGAIN has to focus back on good health habits overall. And those with good oral health habits will likely have a better overall healthy lifestyle. The two are entertwined.
COMBINE THESE TWO THINGS TO AVOID OBESITY
Nothing in the human body acts within a vacuum. Seemingly everything interacts with everything else. This can make isolated experiments looking at single interventions difficult to extrapolate to overall health. Obesity is no different.
There has been growing research on the relationship between the bacteria in our gut and obesity. This may mean that heavy use of antibiotics, especially in our children, may be a strong contributor to the growing obesity epidemic.
But this article adds another piece to this puzzle. Soluble fiber cannot be digested by our gut, but it can be digested by the presence of healthy bacteria into short chain fatty acids. In this study, researchers looked at the effect of propionic acid (one of these short chain fatty acids) on inflammation within adipocytes (fat cells).
They found that adipocytes, when exposed to propionic acid, lowered the production of several pro-inflammatory molecules such as TNF-alpha. This is a very good thing, considering that the inflammation produced by adipose tissues in obese patients begins to wreak havoc on risk for diabetes, further obsesity, cancer and osteoporosis.
The bottom line is that the use of probiotics in anyone (but especially our kids!) needs to be coupled with a diet high in soluble fiber.
COULD ANTIBIOTICS LEAD TO OBESITY?
There should be no shock to find out just how vitally important having the correct balance of bacteria in our gut is. The list of conditions that probioitics have shown an effect on is quite a long one. But this study really looks from a different angle.
The link between bacteria in our gut and obesity is not a newly studied one. The links between dysbiosis (unhealthy composition of bacteria in our gut) and obesity seems to strengthen with each study. This particular study goes even further.
Keep in mind that this is a rat study. The researchers performed a Roux-en-Y gastric bypass on one group and looked at what happened to the rats. The list is quite long.
First, there was a definate, strong change in the bacteria of the gut. What this means, we don’t know just yet, but it strongly suggests that there are ties between obesity, bariatric sugery and the bacteria in our gut. Maybe the changes associated with the surgery, which lead to weight loss, led to the bacterial change. But does the bacterial change lead to the weight loss? We don’t have the answer yet, but since it is well established that the metabolic changes that occur after bariatric surgery occur long before weight loss, this may be a logical progression.
It also raises the important question about whether our heavy reliance on both C-sections and antibiotics may not be contributing to the obesity epidemic. Certainly there are other factors, but we can’t ignore the importance of a healthy gut flora.
CONSTIPATION INCREASES RISK OF THIS???
There are some who say that death begins in the colon. They’re really not too far off the mark. True health is not possible without a healthy gut. There are two issues with constipation.
First is the consequences of constipation. Now, as I sit here typing this post over lunch, I’ll try not to get too graphic, but think of the poor little cell lining the GI tract (colonocyte in the case of the colon). In constipation, the view doesn’t change much. That little guy is exposed to chemicals, byproducts and waste products from compounds that the body had earmarked for elimination. If those nasties were not moving along at a healthy pace and I was a colonocyte, I know I would not be a happy camper.
Because of this, the risk of cancer and diverticulosis / itis goes up. Waste products and toxins that were supposed to be removed get reabsorbed. A perfect example is the glucuronidation of hormones like estrogen. This is process by which the body will get rid of levels of excess hormones that it doesn’t need. It occurs principally in the liver and the conjugated hormones are put into the gut for disposal.
With constipation, these conjugated hormones spend too much time in contact with evil bacteria able to un-conjugate the hormones, sending them back into our bodies in their mutated forms. These mutated forms of hormones such as estrogen can disrupt hormonal balance in the body. For this reason among others, a woman having PMS complaints needs to evaluate their overall gut function.
The second issue is what creates the constipation in the first place. It’s not uncommon for this to begin in infanthood. It seems that parents are sometimes told that their little infant having a bowel movement every couple days is ok…UGH!!! This can be a very early warning sign of food allergies and, in an infant I would look at dairy-related constipation first.
Poor quality diets can also lead to constipation, as can too little fluid intake. Many medications can cause constipation as a side effect. Antibiotics can destroy the healthy bacterial flora. Gall bladder problems may contribute (an entire post by itself).
So, fixing constipation begins with those concerns mentioned above. In the short term, magnesium will easily fix constipation. NEVER use stool softeners as your gut will adapt to them and become dependent. I usually recommend 400 mg of high quality magnesium before bed. This amount may be altered by individual circumstances such as stress levels, base dietary intake and other supplements. But magnesium can’t NOT work (ever heard of anyone not getting cleaned out the day before a colonoscopy?).
Add to this probiotics to balance out the bacterial flora and produce more stability within the gut.
With all this in mind, looking at this particular article and finding a 23% increased risk of heart disease in those with constipation should now make a little more sense. It is not likely a direct result, but rather the lifestyle or food allergies that created the constipation coupled with the problems created by the constipation.
Either way…get it fixed.
November 30, 2003 Research Update
James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Licorice Ethanolic Extract with PPAR-gamma Ligand-Binding Activity Affects Diabetes, Abdominal Obesity and Hypertension.
This animal study gives results of the effects of licorice on the orphan nuclear receptor (so named because we previously were not sure what these genes did when they were turned on) PPAR-gamma. Keep in mind that we are only beginning to understand what these genetic receptors due, but we do know that they are a foundation upon which many aspects of our health (and disease) are built, so any compound affecting these receptors has the ability to impact several disease states. Conjugated linoleic acid and omega-3 fatty acids also affect these receptors. As a side note, this is not the sugar-laden licorice we find in today’s licorice ropes–this is the real stuff.
nutrition.org — Abstracts: Mae et al. 133 (11): 3369. Click here for more information.
Lifespan Prolonged in Autoimmune-Prone Mice Fed Diet with Indole-3-Carbinol.
This study brings up an important factor of one of today’s common medical practices. Indole-3-carbinol has been shown to lower risk of cancer by affecting the 2/16 hydroxylation ratio of estrogen at a genetic level. This study adds the benefit of potential modulation of autoimmune conditions as well. I3C is found in cruciferous veggies such as broccoli, brussel sprouts and cauliflower. The catch? I3C is not the active form–it must be converted to diindolmethane by stomach acid. Might our obsession with shutting down acid production lead to increased rates of certain types of cancer?
nutrition.org — Abstracts: Auborn et al. 133 (11): 3610. Click here for more information.
Conjugated Linoleic Acid Inhibits Cell Proliferation through a p53-Dependent Mechanism.
Remember that CLA is formed in ruminent animals by the action of gut bacteria on certain fatty acids (NOT from the typical “corn-fed” diet of todays’ livestock). This would mean that, in the past, CLA levels were high in the milk and meat of livestock. However, with todays’ poor farming habits, CLA levels are virtually gone. CLA has an action similiar to the licorice noted above–affects PPAR-gamma receptor sites, and as such has a broad spectrum beneficial effect on health. We already know CLA lowers certain cancer rates–now researchers are starting to work towards the “how” portion of the puzzle.
nutrition.org — Abstracts: Kemp et al. 133 (11): 3670. Click here for more information.
Mushroom-derived protein inhibits development of food-allergic reactions in mice.
I realize the title to this one is a little daunting, but the concepts are very important. The rates of atopic disorders and asthma are climbing, for reasons covered many times in past Research Updates (vaccines, sterile lifestyle, killing off probiotics…). While prevention of these conditions is important, it is nice to know we are finding ways to “fix” the imbalance of Th1/Th2 cytokines. This mouse study finds that an extract of mushroom has the potential to shift away from the Th2 dominant profile of atopic/asthmatic patients. Zinc is another nutrient that plays a key role in this important balance.
Oral administration of an edible-mushroom-derived protein inhibits the development of food-allergic reactions in mice – Clin ..Click here for more information.
Comparison of Apolipoprotein B and LDL-C with Other Cardiovascular Risk Factors in the Insulin Resistance Atherosclerosis Study (IRAS).
Whoa!!! Slow down here!! Mainstream medicince is still trying to swallow the idea that CRP and homocysteine are major risk factors for CVD!! We really shouldn’t throw too much research at clinicians all at once. Besides, if we start realizing that cholesterol isn’t the major risk factor for CVD, than what are we going to do with the billions and billions of dollars spent on statins??
Circulation — Abstracts: Williams et al. 108 (19): 2312. Click here for more information.
Joint Effects of CRP, Glycated Hemoglobin in Predicting Future Cardiovascular Events of Patients With Advanced Atherosclerosis.
Cholesterol? Didn’t somebody say cholesterol? Please?? I thought I heard someone, somewhere say cholesterol…
Circulation — Abstracts: Schillinger et al. 108 (19): 2323. Click here for more information.
Effect of firmness of mattress on chronic non-specific low-back pain.
This is interesting, an a question I hear frequently in my office. Unfortunately, the answer is never easy and seems to vary based on the patient. I have a patient that used to work in R&D for Simmons company, and his company found that the firmness needed is dependent upon primary tissue involvement; i.e. muscle problem or joint problem. This would explain why different patients would respond differently to different mattress firmness.
The Journal : Back Issues. Click here for more information.
Retrospective analysis of evidence base for tests used in diagnosis and monitoring of disease in respiratory medicine.
I bring this article to your attention not to chastise, but to illuminate the fact that mainstream medicine has no right casting stones at “alternative” medicine (aspects of which, incidently, have been around for hundreds or thousands of years) and the lack of research. As far as I’m concerned, if an intervention has some basic research, makes sense from the viewpoint of physiology and has high level of safety then it is worth a trial in appropriate cases.
bmj.com Abstracts: Borrill et al. 327 (7424): 1136. Click here for more information.
Caffeine ingestion and fluid balance: a review.
The results of this study are a little surprising for me. Basically, although caffeine is known to have a diuretic effect, this review suggests that this effect is only temporary and only seen if the person is an occasional caffeine ingester.
Caffeine ingestion and fluid balance: a review – J Hum Nutr Diet, Vol 16, Issue 6, pp. 411-420 (Abstract). Click here for more information.
Aspirin Use May Increase Pancreatic Cancer Risk.
Well, doesn’t this just throw a wrench in the works for the “aspirin a day” crowd. I’ve always had a problem with the blatant use of aspirin to lower risk of heart attack. If someone’s really interested, I can give you 15 other things to do to lower risk of heart attack that will not increase risk of something else (actually, in most cases these changes will lower risk across the board for many other chronic diseases). In this case, this presentation showed an increase in pancreatic cancer risk. For those of you that don’t know, pancreatic cancer is close to last on the list of cancers you would like to get. We just don’t have three year survival rates because most don’t live that long (with the exception of Dr. Gonzalez’s work).
News Main – American Association for Cancer Research. Click here for more information.
WHY NOT ALL FIBER IS CREATED THE SAME
As devastating as it is for human health, few I have come across truly understand the difference between a whole grain or refined carbohydrate. The typical answer include white sugars and flours. The real answer is far more expansive.
The whole grain contains the germ (the bulk of the protective nutrients), endosperm (the calories) and the bran (the fiber). To extend shelf life and increase palatability to the oblivious American public, the germ and bran is lopped off and we’re left with the endosperm–the calories minus some 90% of the phytonutrients that where present in the whole grain. The result is a devastating calorie rich/phytonutrient poor staple consumed by the vast majority of Americans. So “enriched wheat flour,” “sugar” and “high fructose corn syrup” all fall into this category.
In comes the fiber story. There is no doubt that fiber, both soluble (able to be digested by the bacteria in our guts to beneficial compounds) and insoluble (“roughage”-not digestible at all) are good for our gut. This study just expands on this, finding that fiber’s benefits extend to lowering pretty much every other cause of death.
But do not fall into the opposite end of the processed grains spectrum. Many products like fiber supplements and many of the big name breakfast cereals (Quaker, Post, Kellogg’s, etc…) contain only the bran. This leaves out the heavy phytonutrient content of the germ that is also devoid in the refined carbs like enriched wheat flour.
I have no doubt that the benefits of whole grains and dietary fiber are derived not merely from the fiber content, but rather the entire blend of the grain, nut, fruit, vegetable or bean. Remember this next time you read an ingredient label. “Fiber” does NOT appear on the ingredient label of a whole grain.
http://archinte.ama-assn.org/cgi/content/abstract/171/12/1061
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