LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

GERD

Acid Blocking Drugs Destroy the Stomach and Lead to Cancer

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ARE YOU TAKING THIS CLASS OF DRUGS FOR STOMACH PROBLEMS?

Proton pump inhibitors like Prilosec, Nexium, Aciphex and a very popular class of drugs for gastritis and heartburn.  This class of drugs was designed ONLY for short term use (several months at most) and yet many patients remain on them for years.  First off, it is very rare for someone to make too much stomach acid.  It’s just not common.  Consider this–stress shuts down digestion.  Digestion also slows down as we get older, leading to stomach acid deficiencies in most seniors.  Knowing this, do you REALLY think you make too much stomach acid and that’s why your doctor put you on this class of drugs?  Most often, symptoms are from too LITTLE stomach acid and supporting digestion (the exact opposite!) actually works very well.  Either way, in this study, researchers found that long term use of PPI in a mouse model actually destroyed the lining of the stomach, leading to even worse digestion.  Bottom line?  This class of drugs is NOT designed for long term use.  If you’ve got a bleeding ulcer, great–this class of drugs will likely save your life.  Short of that you need to look for better options.

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Ulcer Drugs and Children; A Very Dangerous Combination

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side effects of ranitidine
Photo courtesy of https://www.flickr.com/photos/cp

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

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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:

  1. Digestion of proteins.
  2. Turns on other digestive enzymes (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 and calcium.
  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.

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.

Do Gastroesophageal Reflux Disease Drugs Lead to Cancer?

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gastroesophageal reflux disease and cancer
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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.

Baclofen on 24 hour pH metry and symptoms in GERD – (05-05-03)

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Baclofen on 24 hour pH metry and symptoms in GERD.

Okay, so it is interesting that a muscle relaxer such as baclofen has a beneficial effect on reflux disease. However, what I find particularly disconcerting is that this class of drugs raised the pH of the stomach (essentially lowered acid production). Given that many patients (with and many without GI complaints) do not make enough stomach acid, the fact that a drug unrelated (at least until this study..) to acid production would interfere with this essential physiologic action opens up a wide Pandora’s box of downstream mayhem.

Gut — Abstracts: Ciccaglione and Marzio 52 (4): 464

Surgery Advocated as Primary Treatment for Many Cases of GERD – (10-18-01)

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Surgery Advocated as Primary Treatment for Many Cases of GERD

I consider this topic, and this article, especially disturbing. To Western medicine, there are only two options to reflux disease: acid blockers or surgery. My gosh!! Have we forgotten that food allergy is known to play a strong role in lower esophageal tone? Cow’s milk allergy and GERD are well accepted bedfellows in infants–why do we forget this concept when the patient becomes an adult? How about avoiding the nightshade vegetables, caffeine and alcohol long before any pharmaceutical intervention?? Remember–it is not the acid causing the problem, it’s acid getting where it’s not supposed to be…

87th Clinical Congress of the American College of Surgeons Surgery is the only way to cure gastroesophageal reflux disease (GERD) and should be the preferred treatment for Barrett esophagus, according to Dr. Jeffrey H. Peters of the University of California, Los Angeles. Dr. Peters made the case for Nissen fundoplication during a debate on surgical versus medical management of GERD at the 87th Clinical Congress of the American College of Surgeons. In an interview with Reuters Health, Dr. Peters challenged a recent report in The Journal of the American Medical Association, in which Dr. Stuart Jon Spechler and others concluded that antireflux surgery does not obviate the need for medications in most GERD patients. According to Dr. Peters, Dr. Spechler’s group reported that 40% of GERD patients treated with surgery died within 10 to 13 years, and most of the surviving patients required proton pump inhibitors. Dr. Peters challenged the accuracy of those data and said that most of the surgery patients who were put on medical therapy following surgery had no indication for treatment. “If you look carefully at these patients, you will find that only 10% had acid indications that required proton pump inhibition,” he said. Dr. Peters added that surgery should be offered to patients with pH-positive, non-erosive GERD and said surgery is the “preferred treatment for patients with endoscopic esophagitis — but it should be the primary treatment for Barrett’s esophagus.” He said, too, that successful GERD surgery is often more dependent on “repair of the hiatal hernia rather than lower sphincter repair.” Dr. Joel Richter, head of gastroenterology at the Cleveland Clinic Foundation, represented the medical side of the debate and disagreed with Dr. Peters’ claim that surgery can cure GERD. “In some patients you may get a good result for 5 or 10 years, but these patients are going to once again become symptomatic. I think it is more accurate to call surgery a functional repair.” He added that “abdominal stressors don’t go away just because you perform surgery.” But Dr. Peters responded, “In a sense abdominal stressors do go away, because after a good repair, these patients can’t vomit.” Dr. Richter pointed out that surgery is “very dependent on good surgeons performing good operations on the right patients.” Before a standing-room-only crowd of surgeons, Dr. Peters’ remarks received long ovations, while Dr. Richter’s remarks were greeted with polite applause.

Helicobacter Pylori – Friend or Foe to Your Bleeding Ulcer?

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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:

  1. In this group, about 26% had gastroduodenal ulcer disease.
  2. 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.
  3. Non H pylori patients had a longer list of diseases and ill health (as measured by Charlson Index comorbidity scores).
  4. Hospital stay was longer for non H pylori patients (11.4 vs 6 days).
  5. Rebleeding events within 30 days were more frequent in non H pylori patients (11% vs 5%).
  6. 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…

 

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.