WILL GASTRIC REFLUX MEDICINES HARM MY BONES? First off, let me say that long term use of drugs that suppress the production of stomach acid is incredibly devastating to your long term health for a variety of reasons. Shutting down digestion to a screeching halt opens up a Pandora’s box of potential problems that range from diarrhea, constipation, colon cancer, colitis, liver problems, small-bowel-bacterial overgrowth, malabsorption of nutrients and, in this study, fractures. It is a very rare instance when someone makes too MUCH stomach acid. Most of the problems that patients experience are actually from having too LITTLE stomach acid. Supporting digestion can work wonders in most cases, as well as stress mangement (which is what usually starts the problem in the first place).Shutting down digestion to a screeching halt opens up a Pandora’s box of potential problems that range from diarrhea, constipation, colon cancer, colitis, liver problems, small-bowel-bacterial overgrowth, malabsorption of nutrients and, in this study, fractures. It is a very rare instance when someone makes too MUCH stomach acid. Most of the problems that patients experience are actually from having too LITTLE stomach acid. Supporting digestion can work wonders in most cases, as well as stress mangement (which is what usually starts the problem in the first place). Read More
Digestive Complaints
Reflux Disease, Barrett’s Esophagus and Esophageal Cancer: Critical Detail
Patients who have reflux are almost exclusively given ulcer drugs with the rationale to block the development of cancer of the esophagus.
The thinking is that is you can block the constant irritation of acid on the lining of the esophagus, which was not designed for high levels of acidity, you can stop the progression to neoplasia (neoplasia = precancerous cells). Neoplasia can occur with any tissue that is under constant attack and repair. The more a tissue has to replace damaged cells with new ones, the more likely an error in cell division is to occur. Errors can lead to cancer.
At the surface, the idea of blocking acid may seem like a good idea. At least it does until you factor in that in no way does this treatment approach address the reason the reflux is present in the first place. Then, when you factor in the fact that stomach acid is just kind of important in say, EVERYTHING, as this approach begins to sounds like a disaster waiting to happen.
Deep down inside the drug companies are probably aware of this. That’s why every SINGLE drug designed to block stomach acid production clearly states that it is for short-term use only. Usually no longer than 3 months.
And yet patients are put on these drugs for years and years and years and the devastation to health is virtual incalculable.
Our bodies digest. And then our bodies do everything else. Without an intact digestive system optimal health can NOT be achieved. And ulcer drugs absolutely destroy your body’s ability to digest.
As I’ve said consistently in previous articles, if you’ve got a bleeding ulcer (which most likely came from taking aspirin or ibuprofen…) it is not the time to worry about long-term effects of blocking acid. These drugs can be life-saving if you have a bleeding ulcer.
Any other time, however, they are one of the worst things you can take long-term.
The real answer to the problem lies in figuring out where the reflux is coming from. Food allergies (like gluten, dairy, corn, soy), abdominal obesity, tight belts and stress can all play a role in reflux. While fixing some of these can be long-term solutions, digestive enzymes can frequently work miracles in the short-term.
But what about the risk of developing cancer of the esophagus?
Turns out that acid-blocking drugs do little about the progression from Barrett’s esophagus (a pre-cancerous condition of the esophagus). Rather, the answer is far more complex. Things like nitrates in your food choices (which you can read about in a previous article by clicking here) will affect risk.
This particular study gives us even more information about factors that will greatly affect your risk of developing cancer of the esophagus.
In it, researchers looked at the relationship between physiology’s arch enemy, inflammation, and the development of esophageal cancer. Specifically, they looked at several markers in a small group of 397 people diagnosed with Barrett’s esophagus:
- C-reactive protein (CRP)
- Interleukin-6 (IL6)
- Soluble tumor necrosis factor (sTNF) receptors I and II
- F2-isoprostanes (a marker of oxidative stress)
They looked at several other lifestyle factors as well. Here’s what they found:
- Those with higher CRP levels had an 80% higher risk of esophageal adenocarcinoma.
- Even worse, those with higher CRP and an elevated waist–hip ratio had a 198% higher risk.
- Higher CRP and smoking upped risk 177%.
- Higher IL6 levels had a 200% higher risk of esophageal cancer.
- Elevated waist-to-hip ratios and smokers did not have a further risk above IL-6.
When you look at these numbers, pay attention to the fact that inflammation is NOT reduced by the use of acid-blocking drugs. In many cases, the use of these drugs to block normal digestion would increase inflammation.
Another important thing to note is that having an elevated waist-to-hip ratio (meaning these people were very likely pre-diabetic) was more dangerous than cigarette smoking.
Got that? More dangerous than cigarette smoking. Everyone knows that smoking is bad for you, but very, very few people truly understand the devastation that pre-diabetes wreaks on your long-term health.
If the 2/3 of society (by my estimation) that are pre-diabetic understood these risks better, maybe we’d pay a little better attention to our lifestyle choices.
The last comment I have to throw out this is that drugs that block acid production are well-known to negatively affect bone health. Poor bone health leads to an increased risk of diabetes (in case you were not aware of this relationship, you can read about it in a previous article by clicking here).
Following this line of thinking, it may very well be that the treatments we THINK are protecting the esophagus are actually increasing the risk of the esophageal cancer we are trying to stop.
Ulcer Drugs and Children; A Very Dangerous Combination
Before we even start, I just need to go on record saying that I think that giving drugs that block stomach acid production is a very bad idea in adults. In children, it borders on a travesty.
I think most of us, regardless of medical background, could easily agree that digestion is very important to long-term health. And digestion centers around our body’s ability to make stomach acid. Without stomach acid the entire process begins to unravel, opening up a Pandora’s box of epic proportions.
I further stand on the belief that ANY provider writing a prescription for a drug that blocks the production of stomach acid should be able to look you in the eye and give you at least 10 very important physiological processes that will be negatively impacted by this drug. If they cannot do this, they have no business interfering with aspects of the body that they don’t fully understand.
This may be a strong statement, but it boils back down to just how massively important digestion is for long-term health.
Consistent with prior blog posts on this topic (which can be read by clicking here) I do have to note that this class of drugs for someone with a bleeding ulcer can be life-saving. But every bit of paperwork that comes with this class of drugs makes it clear that it is for short-term use (usually 3 months or less). Despite this, I frequently see patients who have been on them for YEARS (for those of you not good with math, years > months….).
This particular study looks at just one of the serious side effects of ranitidine and other acid-blocking drugs when used in children (although studies have shown the same concerns with adults). Here’s what they found:
- 46% of kids taking acid-suppression medication had bacterial growing his or her stomach (compared with 18% of the controls). This is a 255% increase in bacteria present in the stomach of kids on these drugs.
On the surface, this sounds really bad.
Bacteria growing in the stomach where it is not supposed to grow. (Also seems ironic in light of the use of acid-blocking drugs for H. pylori infections in the stomach) But the news gets far worse. Researchers looked at what types of bacteria were growing in the stomach and here’s what they discovered:
- Staphylococcus 1,275% more likely to be present.
- Streptococcus 691% more likely.
- Veillonella 956% higher risk.
- Dermabacter 478% higher risk.
- Rothia 638%.
- To top it all off, the number of bacterium found were higher in treated patients.
- For those kids who had proximal nonacid reflux, there were higher concentrations of certain bacteria in his or her lungs.
While they did not find a difference in the bacteria or number of bacteria in the lungs of those on acid-blocking medications who did not have proximal nonacid reflux, it does raise some serious concerns about having bacteria known to cause respiratory infections growing in the stomach. The esophagus is just way too close to the trachea for comfort.
The take home message is that using acid-blocking drugs carries significant risk to long-term health. While it may or may not contribute to upper respiratory infections (and there is good evidence that it does) the long list of additional side effects remains scary. There are many ways to help manage your symptoms, from DGL (a special form of licorice that does not affect blood pressure), vitamin U (a compound that is present in cabbage and can be very good for the mucosa of the gut), dietary changes and stress management. While some of these may require considerable upheaval of where you are at health-wise, it’s certainly much safer in the long run.
Surprising Cause of Heartburn and an Immediate Fix
Heartburn, reflux, indigestion. Regardless of what you call it, it sucks. Especially if it keeps you from eating the foods you like.
Worse, there are few things that cause me to pull my hair out of my head (what’s left anyway–these days I need tweezers and it’s not so gratifying…) then patients who have been on acid-suppressing drugs for YEARS. If you look at the little white insert that came with the prescription you will see that this class of drugs is for short-term use only.
And yet I had a 40-something-year-old new patient just last week who was told by his doctor that he would need to take these for the rest of his life. And we’re going to assume that “the rest of his life” was going to be longer than 3 months. Clearly many doctors do not seem to understand the dynamics of digestion and how important it is to good health.
On the flip side, if you have a bleeding ulcer, acid-blocking drugs will save your life. You’ll get no argument from me on that one. But for almost every other situation, acid-blocking drugs will, without question, cause more problems than they will solve. I have covered the functions of stomach acid in the past, but here’s the brief list again:
- Digestion of proteins.
- Turns on other digestive enzymes (they are produced in an inactive state).
- Sterilizes everything so no bacteria or funguses make it past the stomach.
- Helps to absorb certain critical nutrients like vitamin B12 and calcium.
- Turns on certain anti-cancer compounds in foods (like indole-3-carbinol in broccoli).
- Turns the stomach contents acidic. This is critically important. The pH of the stomach contents have to be more acidic than 5 ish in order for the pancreas to release secretin to neutralize the stomach contents. If this does not happen (as with drugs) the rest of the GI tract has to deal with acid contents that are too strong for it, leading to long-term damage.
So you can see that it’s important. Flip this around to look at the side effects of acid-blocking drugs and the list is long: cancer, bone loss, increased risk of pneumonia and asthma are on the short list. Here’s the kicker: very, very few people make TOO much stomach acid. Certain tumors may lead to too much stomach acid, but the vast majority of people make too little. This lack of stomach acid stems from several causes. First, stress shuts down stomach acid production. This pretty much keeps half of society from making too much stomach acid. The second reason is that, as we age, the region of the stomach (the parietal cells in the fundus) that produces stomach acid slowly wears away, just like everything else in your body, making it literally impossible to make too much stomach acid as we age.
Often, reflux-type symptoms are from poor digestion. Support digestion with digestive enzymes and reflux can improve dramatically. I have seen this happen time and time again in practice. However, in case this doesn’t work, there might be an even simpler solution.
Loosen your belt.
Common sense could tell us that increased pressure in the abdomen would push up the contents of the stomach and lead to reflux. But it’s nice to have the theory played out in a real live overpriced study. In this particular study, researchers looked at a group of 24 volunteers who had no symptoms of heartburn, half with normal waistlines and half with increase waistlines. They were then fed meals with a waist belt on and another meal at a different time with no waist belt on. Here’s what they found:
- Both the use of a waist belt and have an increased waist circumference both pushed the meeting point of the stomach and esophagus further up into the esophagus.
- When the lower portion of the esophagus relaxes, this region should drop back down, but the use of a belt kept this from happening.
- This lack of movement of the esophagus also happened in those with larger waist circumferences.
- The waist belt led to higher pressure in the esophagus (versus the pressure in the stomach).
- The waist belt led to a lower pH level (meaning more acid) higher in the esophagus.
- Stomach acid exposure in the esophagus was highest in the obese subjects with belt.
Overall, both the waist belt and being overweight led to more acid being exposed to the esophagus for a longer period of time. Keep in mind that none of the volunteers in this study had symptoms despite the fact that the esophagus was clearly being damaged by acid. Obviously maintaining an ideal body weight is a good idea for reflux, but it seems like avoiding tight-waisted pants or wearing a belt might be a good plan to follow.
Surprising Finding on Newborn Acid Reflux: Be Very Scared About Prilosec
Parents of newborns are always worried about their little one. But this can lead to misguided trust in the wrong pediatrician if the little one is sick.
Excessive spitting up, crying after eating and refusing to eat can all be symptoms of what may be diagnosed as infant reflux. The less wary pediatrician, if symptoms are creating a problem with eating enough, may recommend a prescription of Nexium or Prilosec. The first time I heard of this practice, I was astounded that anyone would even consider giving a drug that blocks digestion to an infant. After all–what does an infant do? Eat, poop and cry. Two of the 3 are intimately involved with digestion. Using a drug to block digestion is pretty much nixing the life of an infant.
It’s bad enough in an adult. Shutting down digestion is a very, very bad idea except in a few scenarios. If you have a bleeding ulcer, for example, Nexium can very well save your life. But if you’ve got a case of heartburn and use acid-blocking drugs for years on end, you are absolutely destroying your body’s essential functions and will open up a huge Pandora’s box of problems.
In infants, this concern is multiplied tenfold. The real kicker is that drugs are only needed in rare cases because natural approaches for infant reflux can work so well. The most recent article I had covered had to do with the use of vitamin B12 in infants with reflux and regurgitation that can be read by clicking here. The results were pretty impressive.
Just in case you are one of those parents whose pediatrician has recommended an acid blocking drug for newborn acid reflux, this particular study should scare the bejesus out of you. In this study, researchers looked at just how much digestion of proteins was going on in the stomach of 3 little ones. This is important because, if there is a lot of digestion going on and we slam this process with drugs, it’s going to have an unpredictable long term effect on your infant’s long-term health. Here’s what they found:
- Milk from 3 was collected and compared to a small sample from the stomach of the infants (who were 4 to 12 days old).
- Milk from the moms contained almost 200 distinct peptides (segments of proteins), demonstrating that there was some digestion of the breast milk either during lactation or between milk collection and feeding.
- In the newborn stomach samples, 649 milk peptides were found, showing that a large amount of digestion was occurring in the stomach.
- A total of 603 peptides differed significantly in quantities between breast milk and the infant stomach samples.
- Most of the identified peptides have been shown to have immunomodulatory and antibacterial properties.
So what does all this mean? It means that, even from day one, an infants digestive process is up and running full tilt, turning proteins from foods into protective compounds that will steer the development of the immune system for a lifetime. I cannot begin to contemplate the long-term damage that using drugs to block acid in newborn acid reflux will cause.
Do Gastroesophageal Reflux Disease Drugs Lead to Cancer?
For those who have educated themselves, the big fear of uncontrolled gastrointestinal reflux disease is that it could turn into esophageal cancer.
Because of this fear, people accept the idea that using drugs that block stomach acid is the right thing to do. After all, acid splashes up on the esophagus and damages the lining because it is not designed for that type of abuse. The damaged lining of the esophagus tries to heal and, over time, these cells break down from the chronic damage and become precancerous. This condition is referred to as Barrett’s esophagus and it is a strong risk factor for later development of esophageal cancer.
For many years now, mainstream medicine has approached this problem using drugs like Nexium and Prilosec with a tenacity of the papparazzi on Britney Spears. But blocking stomach acid, an absolutely critical component of digestion, wreaks havoc on your body’s ability to live healthy. Few drugs will create as many long-term problems as drugs to block stomach acid. With the exception of maybe antibiotics, which can take years to recover from, if ever.
I have certainly covered the dangers of blocking stomach acid in previous articles that can be read by clicking here, so I won’t go over them again. But let’s just sum it up by saying that it’s a baaaad idea. Of course, if you have a perforated ulcer and you are bleeding internally, than this class of drugs will be a lifesaver. But for the rest of you not lying in a hospital bed pasty white from anemia this is not a good idea.
So what does all this have to do with this particular article? In it, researchers took an interesting look at the bacteria in the upper gastrointestinal tract and the risk of developing esophageal or stomach cancer. More specifically, they looked at how much diversity there was in the bacteria found. Keep in mind that higher diversity is usually a good thing and a sign of a healthier bacterial flora. (Antibiotics decimate bacteria flora diversity, just so you know…) The bacterial diversity was then compared to known markers that increase the risk of development of esophageal and gastric cancer (serum pepsinogen I/pepsinogen II ratio or PGI/II for gastric cancer risk and esophageal squamous dysplasia or ESD for esophageal squamous cell carcinoma). Here’s what they found:
- Lower microbial diversity (number of bacterial genera per sample) was led to higher risks for both gastric and esophageal cancer.
Before you can realize just how important this is, you need to know that the use of drugs that block the production of stomach acid interfere with the normal balance of bacteria in the gut. When you block stomach acid, you’ve just destroyed your body’s ability to kill off certain bacteria that are NOT supposed to grow in the GI tract. This leads to a condition known as small bowel bacterial overgrowth–bacteria growing where it is not supposed to be growing.
In general, any drug that is going to interfere with the normal function of the GI tract is going to upset the delicate balance of bacteria residing there. This means that antibiotics and drugs that block acid production may very well contribute to the development of the very cancers that doctors are mistakenly using these classes of drugs to try to prevent. Talk about a backwards system.
This also means that using heavy hitting probiotics (like VSL-3 high potency probiotics that I am a very big fan of for those patients who have really screwed up their systems with antibiotics) should be an important part of your cancer-prevention routine.
Helicobacter Pylori – Friend or Foe to Your Bleeding Ulcer?
Since bleeding ulcers can be fatal, we can all agree that they are NOT a good thing. Along these same lines, anything that can improve or worsen the outcome of a bleeding ulcer is important to know.
To begin, it would be important to know what can lead to a bleeding ulcer. Top of the list is drugs, most notoriously the anti-inflammatory class of NSAIDs. They kill anywhere from 16-21,000 people per year from bleeding ulcers alone (add in the cardiac dangers and the number is much, much higher). Poor lifestyle habits like excessive alcohol intake and smoking are on the list as well.
As much as I have an issue with the overuse of pharmaceutical drugs for every minor and major ill known to man, they do have a place in society. Bleeding ulcers is one of these. It’s not the time to try natural approaches when your life is on the line. However, if you’d like to avoid a bleeding ulcer in the first place, or if you suffer from gastritis or reflux (GERD, heartburn), then medicine has no place and will likely make the condition worse.
GERD is is quite common and is routinely treated with drugs that shut down acid production in the stomach under the mistaken idea that these patients make “too much” stomach acid. There is absolutely no evidence to support this wild notion of having too much acid. I had a new patient in the office today that has been on omeprazole (generic Prilosec) since high school (about 10 years). Not an uncommon story despite the fact that this drug was only designed for short term (3-6 months) use. If you want to really screw someone’s health up, go ahead and shut down digestion indefinitely. It’s not important anyway.
Instead of shutting down digestion, going the opposite direction and actually supporting digestion is a great first approach for most upper digestive disorders. Our office has seen some pretty amazing outcomes in patients who had been told they “make too much stomach acid” but really had the opposite and took digestive support supplements. When you consider that stress shuts down digestion, how many people in todays’ stressed-out society do you think would actually qualify as making too much stomach acid?
Some of you may have heard about a bacteria that contributes to ulcers called Helicobacter pylori. Back in the mid 1980′s, a doctor by the name of Barry Marshall drank a concoction of the bacteria H. pylori to prove that ulcers were caused by bacterial infection. He ended up with a Nobel Prize and forever changed medicine’s view of ulcers. Thus began the “blinders on” approach to eradication of H. pylori every time it was found. Destroying this bacteria is a good thing, right?
Of course, we can all agree that wanton use of antibiotics (and they use 2 types of antibiotics in the treatment of H. pylori) is never a good thing. I have long stood by the belief that H. pylori is merely an opportunistic infection, growing in strength when the patient is not taking care of themselves. The research continues to support this viewpoint, although medicine continues to focus on wiping out this bacteria when it is found.
This particular article adds more weight to the idea that we should not be wantonly killing off the H. pylori bacteria when it is found. Researchers looked at a group of 2242 patients with upper gastrointestinal bleeding and what effect the presence of H. pylori had on the outcomes of the bleeding. Here’s what they found:
- In this group, about 26% had gastroduodenal ulcer disease.
- Of this group, about half (228, 10% overall) had evidence of Helicobacter pylori infection and half (216, 10% overall) had no evidence of Helicobacter pylori infection.
- Non H pylori patients had a longer list of diseases and ill health (as measured by Charlson Index comorbidity scores).
- Hospital stay was longer for non H pylori patients (11.4 vs 6 days).
- Rebleeding events within 30 days were more frequent in non H pylori patients (11% vs 5%).
- Rebleeding was most frequent in non H pylori patients who had no reported use of NSAIDS (18%).
Overall, the presence of H. pylori led to better outcomes in those patients who were admitted to the hospital with upper gastrointestinal bleeding. Kind of flies in the face of Helicobacter pylori being a dangerous invader that needs to be destroyed on sight with a concoction of multiple antibiotics…
Does Your Infant have Reflux? Two Things to Try Before Meds
I still remember the first time, several years ago, I had a patient tell me that their infant had been put on Prilosec for heartburn.
Heartburn in an infant. Seriously? Maybe it was the chili dog and beer.
If we can believe that a newborn infant can have reflux, we would have to assume that Mother Nature screwed up somewhere. I’m not sure about you, but I refuse to believe that this could ever be the case.
So, if your infant is seemingly upset and spitting up, what else could be wrong if it’s not reflux? This is a question that never seems to be asked by the pediatrician. But it’s a critically important one; instead we just accept that your little son or daughter “makes too much acid” and leave it at that.
There are several reasons why an infant would show signs of reflux. But first, we need to clarify something. Just because your child is spitting up and seems to be negatively affected by eating does NOT mean that reflux is the diagnosis. Quite frankly, this is very far from true. In a study published in 2008 that can be read by clicking here, researchers looked at just how likely a group of infants who were given a prescription for acid blockers actually met the diagnostic criteria for reflux.
Only 8 out of 44 prescriptions. 18%. Talk about over prescribing.
For argument’s sake, let’s just say your child happens to fit into the small percentage that truly does have reflux. They need medication, right? Unfortunately, the research to date does not support the use of medications for treatment of GERD in infants (you can read more by clicking on a previous article here).
Despite all of this, infants are still put on medications for reflux at the recommendation of his or her pediatrician. How can this still happen despite the concerns and research noted above? This particular study may give us some insight into this question. Researchers looked at what influence the label of “GERD” made on the parents’ likelihood of medicating the infant. Here’s what they found:
- Parents who received a GERD diagnosis were interested in medicating their infant, even when they were told that the medications are likely ineffective.
- Parents not given this disease label were interested in medication only when medication effectiveness was not discussed (and hence likely assumed).
The mere diagnosis given (and remember that, in only 18% of cases is this likely to be accurate) had a serious impact on whether or not the parents were going to medicate, DESPITE being told it was not likely to be effective!
Just how brainwashed are we in society today? We get a disease label and our brains, based on seriously successful marketing by the drug companies, equate the disease with the use of the drug. It doesn’t matter that it’s not going to work.
Since medication is such a poor option, we need to get back to the question of where the problems may be stemming from. The are two very common situations:
- Food allergies (think dairy, corn, wheat….). If mom’s nursing, she needs to look at her diet. If the baby’s on formula, consider a hydrolyzed formula that will be easier on the baby’s sensitive immune and GI system.
- Dysbiosis. The wrong bacteria in the system. This means probiotics are critical. Some pediatricians may feel this is too early, but since the baby gets exposed at birth and it shows up in breastmilk, I think Mother Nature would strongly disagree.
So before your child is put on ridiculous medications for a condition that likely doesn’t exist, consider the above 2 tips to see if it helps. I think you’ll be surprised.
If your child had digestive issues as an infant, what natural approaches did you find that helped the most?