LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

reflux

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?

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.

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