LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Digestive Complaints

Did Your Doctor Tell You That You Make “Too Much Stomach Acid?”

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The body digests and does everything else.  In other words, digestion is absolutely critical to good health.  Period.  And this process hinges on stomach acid.

Without proper digestion, you open up a large Pandora’s box of problems because stomach acid has many different roles.  With this in mind, you can begin to see how both emotional stress as well as medications that block acid production (like Aciphex, Nexium, Prilosec) could ruin your health.

First, though, I do need to clarify that this class of drugs has its place.  If you’ve got a bleeding ulcer it’s not the time to discuss changing your diet and chewing your food better.  It’s time to protect the lining of the stomach from the acid so that it does not break open and spill your blood inside your abdominal cavity.  This can be fatal.  For everyone else, however, blocking stomach acid is a bad thing.

Ironically, very few people make too much stomach acid.  This is especially true as we age, where the region of the stomach begins to wear away with age, leaving up to 1/3 of seniors with achlorhydria (NO stomach acid production).  Thus, one would think that a senior citizen would be a very unlikely candidate for any type of drug that blocks acid production.

Just so you can get a better idea of what stomach acid does, here is a short list:

  1. Digestion of proteins
  2. Turns on other digestive enxymes (they are produced in an inactive state)
  3. Sterilizes everything so no bacteria or funguses make it past the stomach
  4. Helps to absorb certain critical nutrients like vitamin B12
  5. Turns on certain anti-cancer compounds in foods (like indole-3-carbinol in broccoli)
  6. 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.

This list is longer, but you get this idea.  It’s important.

As I mentioned, the average senior absolutely does not make enough stomach acid.  Certainly not enough to warrant medications that shut down acid production.  And yet, we still write those prescriptions.  Sometimes out of mere habit.

This practice is especially common when seniors end up in the hospital, and this practice has been increasing over the past few years.  But, given how much stomach acid does for our health, is this a good idea?

The answer turns out to be a no.

In this particular study, researchers looked at a group of seniors discharged from the hospital to see if being given a prescription for proton pump inhibitors had an effect on his or her likelihood of dying within a year.  Here’s what they found:

  1. Use of acid blocking drugs increased the risk of dying within a year by 51%.
  2. For those prescribed high-dose drugs, the risk skyrocketed to 259%.

The bottom line is that it is highly likely that shutting down acid production as you get older is a bad idea that will adversely affect your health and longevity.  Instead, consider a digestive enzyme, chewing your food slowly or a tablespoonful or two of apple cider vinegar to help your body do what it is supposed to do.

Eosinophilic Esophagitis Treatment with the Esophagitis Diet

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Say that 3 times fast…Eosinophilic Esophagitis Treatment with an Esophagitis Diet. This autoimmune condition has been on the rise, especially in children.

Overall, most autoimmune disorders, especially those tied to the gut (think Crohn’s disease, ulcerative colitis and eosinophilic esophagitis) have been on the increase.  The scare thing is that this rise has been playing out in children more so than adults.  I have no doubt that our sterile “hygienic” lifestyles are to blame.  The combination of antibiotics and vaccinations to try to wipe out every possible communicable disease, coupled with antibacterial wipes, lotions, facial tissues and toilet paper (ok..maybe not toilet paper, but only because they couldn’t find a good market for it…), has left our immune systems dysfunctional.

Another strong player in the autoimmune circuit is food allergies.  Actually, let me correct that.  When I think of allergies, I think anaphylactic shock from peanuts, skin prick testing and allergy shots.  What seems to play a larger role is food sensitivity.  Allergies are hard-wired into our immune system, but sensitivites come and go based on the overall health of the individual.

Eat a food you’re sensitive to day in and day out for years and you’re systems not going to be very happy with you.  Avoid that food for several weeks and your immune system begins to calm back down.

So how do we determine if we are sensitive to a food?  I can tell you that I’m not a big fan of skin scratch testing or even bloodwork such as a RAST panel.  Blood allergy testing can get very expensive (it’s easy to rack up a $1,000 bill).

I prefer elimination diets.  Approximate cost?  $0.  Accuracy?  Pretty darn high if done correctly.  High enough to be considered the gold standard for allergies and sensitivities.

Basically, in an elimination diet, you avoid all commonly sensitive foods (principally dairy, wheat, eggs, corn and soy) for 2 weeks.  If you begin to feel better in this time period (based on whatever symptoms caused you to try the elimination diet in the first place), you reintroduce one of these foods at a single point and check for symptoms to return within a few days.

This is considered elimination with subsequent food challenge.

So what does this have to do with the tongue twisting eosinophilic esophagitis? 

Researchers have already determined that food allergies play a huge role in flare ups and symptoms of esophagitis in children.  I remember writing a blog on the relationship between celiac disease and reflux esophagitis in March of 2003, almost a decade ago.  This is not new news.

So, since the relationship between food allergies in children is well established, someone decided to ask if the same relationship was present in adults.  What brilliant thinking from the researchers, because most GI docs don’t make too many recommendations on food elimination diets.

In this particular study looking at food elimination diets in adult with eosinophilic esophagitis, the results were nothing short of shocking:

  • Common symptoms of EoE included dysphagia (96%), food impaction (74%), and heartburn (94%)
  • The number of eosinphils (white blood cells related to allergy) dropped 76% with the diet
  • Symptom scores decreased in 94% of those on the program (yes–you read that right–94%, as in “almost all”)
  • After food reintroduction, eosinophil counts returned to pretreatment values
  • Foods most problematic were wheat (60%) and milk (50%), soy (10%), nuts (10%), and egg (5%)
  • Skin-prick testing predicted only 13% of foods (in other words, just short of worthless)

Realise that NONE of the patients in this study realized that they had food allergies / sensitivities prior the program.  Which also means that their gastroenterologists likely never brought the subject up.

Remember that 94% of patients complained of heartburn, despite being put on acid suppressive drugs like Nexium or Prilosec.  This means that ACID WAS NOT THE PROBLEM.

Did I mention that acid was not what was causing the reflux symptoms in these patients?

So, by giving acid suppressive drugs, not only did their physicians completely disrupt healthy digestion, but they did not address the real problem.  These food allergies, left to run rampant for decades create the chronic inflammation associated with other diseases such as osteoporosis, dementia, cancer, heart disease and stroke.

So, if you deal with reflux, regardless of whether is it eosinophilic esophagitis or not, have you identified any foods that contribute to your symptoms?

GASTRIC ACHLOHYDRIA CAUSES SEVERAL DISEASES – (07-18-05)

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Gastric achlorhydria in mice causes severe hyperplasia, mucocystic metaplasia and upregulation of growth factors

I am a strong opponent to pharmacological therapy for acid suppression in almost every case.  I’ve personally seen many patients respond very positively to actually supporting digestion instead of blocking it.  I strongly feel that any doctor that prescribes acid suppressive therapy ought to damn well be able to give at least 8 functions of stomach acid and the potential ramifications on long term health if that stomach acid is suppressed.  If they are unable, they have NO RIGHT making that prescription.

Digestion is an incredibly fundamental part of our health, and with the chronic stress many our under in today’s society, they are actually produce TOO LITTLE stomach acid.  Suppress that further with drugs and you open up a Pandora’s box of health problems.  This mouse study finds an increase in precancerous activity with chronic acid suppression.  Big surprise.

Read entire article here

DIGESTION AND STOMACH ACID LEVELS EFFECT LOW WEIGHT INFANTS – (03-27-06)

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Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

While this study was done in low birth weight infants, it again supports the role of healthy digestion and stomach acid levels in acting as a sterilizing agent to all bugs making it into the stomach. While this inherently makes sense to most people, I have never once had a patient come into my office on acid suppressive therapy (and this is quite a regular occurrence) and get anything remotely akin to informed consent about the potential side effects of this class of drugs.

In adults, studies have shown that acid suppressive therapy in adults contributes to small bowel bacterial overgrowth–a growth of bacteria growing in the small intestine in a location where nothing should be growing.

Read entire article here

GINGER PREVENTS NAUSEA AND VOMITING – (02-13-06)

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The efficacy of ginger for the prevention of postoperative nausea and vomiting: A meta-analysis

Ginger is one of those knee-jerk natural compounds that I always think of first when it comes to nausea.

This review of 5 separate studies found ginger very effective at reducing post surgical nausea and vomiting. Given the high safety level and low cost, this one makes ginger a no-brainer for first line of defense in many cases of nausea.

Read entire article here

Heartburn or Prediabetes, Which Leads to Esophageal Cancer?

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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:

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??

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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 long-term memory intact, 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 given to 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)

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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.

Read entire article here