LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Digestive Complaints

ACID BLOCKERS ACTUALLY PROMOTE ESOPHAGEAL CANCER?

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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?

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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:

  1. 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.
  2. Maintain an anti-diabetic lifestyle. Yes, Virginia, diabetes is linked to GERD as well.
  3.  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.
  4. 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.
  5. 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

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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 obesity, 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.

Read more…

COULD ANTIBIOTICS LEAD TO OBESITY?

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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.

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CONSTIPATION INCREASES RISK OF THIS???

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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.

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WHY NOT ALL FIBER IS CREATED THE SAME

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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

REFLUX–CAN SURGERY REALLY BE A GOOD OPTION?

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Before I give my opinion on this, we need to get some background info.  The most important aspect is digestion.  Our body digests and assimilates food, and then there’s everything else.  Digestion is an absolutely essential, critical, important, cardinal and crucial (sorry…ran out of synonyms, but you get the idea) of health.  Without it, the rest of the body begins to break down.

So what slows down digestion?  Age.  As we get older, the region of our stomach that makes stomach acid wears down, just like our joints.  This makes it almost impossible for someone over 50 to be making too much stomach acid (despite what they were told by their doctor).  Next is stress.  Our fight or flight response does not lend well to digestion.  when you’re running away from a sabre toothed tiger, the body is not going to divert energy towards digestion (making stomach acid is an extremely energy-expensive process) and away from the heart, lungs and leg muscles.

Back in the 80’s an internal medicine resident by the name of Marshall proved that a little critter named Helicobacter pylori could greatly contribute to the development of ulcers and he singlehandedly changed the treatment paradigm.  Unfortunately, we now view H. pylori as a pathogen that needs to be destroyed rather than a bacteria growing because the environment is ripe for growth (low stomach acid, absence of protective bacteria like Lactobacillus).

Add to the above, drugs like ibprofen (NSAIDs are responsible for some 20K deaths per YEAR due to bleeding ulcers) and you’ve got a nice mixture for the development of gastric problems (ulcers, gastritis, reflux). 

Despite all the above factors that are fixable, we brush them aside and put people on acid suppressive drugs like Nexium and Prilosec for YEARS!!  Read the label–this class of drugs was NEVER designed to be used longer than 6 months.  If you’ve got a bleeding ulcer, guess what–you NEED them.  Any other scenario and they are hurting more than helping.

What about reflux and esophageal cancer?  Aren’t they needed?  Nope.  Don’t change the trajectory towards cancer so it must not be the acid (more on this in another post).  What about heartburn and the discomfort?  Besides proper dietary choices, supporting digestion rather than destroying it usually goes a long way towards helping symptoms.  This means using apple cider vinegar or digestive enzymes to support digestion rather than destroying it with drugs.

So what if you’ve done everything right and even digestive enzymes aren’t helping?  Should someone just stay on the drugs long term.  Absolutely, positively without a doubt the answer is NO.  The long term consequences of shutting down an absolutely essential part of your functioning is a very long list (cancer, inflammatory bowel disease, IBS, osteoporosis, depression, etc, etc, etc…).

This is the perfect time to consider surgery to help strengthen the lower esophageal sphincter and no longer need the drugs.  Yes–there is always a time and place for surgery.

http://jama.ama-assn.org/content/305/19/1969.abstract

HEARTBURN IN INFANTS?

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I remember the first time I had a patient come in and tell me that their pediatrician put their infant on Prilosec.  I had to clean the wax out of my ears and ask for clarification.  Yes–the latest abuse of the pharmaceutical companies had begun in earnest.  For me, our bodies digest and then do everything else.  It’s absolutely, positively essential for good health.  ANY interference with digestion is a very bad idea with long ranging consequences.  To use this class of drugs in an adult is bad enough–to push them on scared and concerned parents should be malpractice.

We have seen several studies finding that this class of drugs given to children is massively abused and completely ineffective at fixing the problem.  This study confirms this by looking at multiple studies.  Bottom line is that they have not been shown to be effective at reducing symptoms of heartburn (GERD) and there are NO safety studies.

So what do we do with an infant who may be having heartburn?  If nursing, change mom’s diet.  Get rid of common allergens like dairy.  Absolutely add probiotics.  If formula fed, switch to a hydrolyzed formula like Nutramagen or Alimentum.

When the older child has reflux, consider apple cider vinegar or digestive enzymes.  This is almost always a result of a stressed out child.  Help them NOW manage the stress in their lives.

Either way, please consider heavily, regardless of the age, the massive consequences of shutting down digestion.

http://pediatrics.aappublications.org/cgi/content/abstract/127/5/925