LifeCare Chiropractic

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GERD

Gastroesophageal reflux disease related to diabetes – (01-29-04)

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Gastroesophageal reflux disease related to diabetes

This is what I like to hear. Too many times we view GERD as it’s own entity that requires separate treatment (i.e. antisecretory therapy). Rarely do we view the big picture and what may be causing the GERD in the first place. I already suggest avoidance of the typical no-no’s (caffeine, alcohol, nicotine, nightshade veggies) as well as digestive enzymes/HCl. It is nice to have another contributing factor to look at.

Gastroesophageal reflux disease related to diabetes: Analysis of 241 cases with type 2 diabetes mellitus – J Gastroenterol He..

Read entire article here

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.

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