LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

ulcer

Ibuprofen Class of Drugs Kills 21,000 Per Year

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ARE YOU AWARE THAT THIS COMMON CLASS OF DRUGS KILLS 21,000 PEOPLE PER YEAR?

Almost everyone is surprised about the annual number of deaths that occur due to the Non-Steroidal Anti-Inflammatory Drugs (like ibuprofen).  This number, in light of the increased risk of NSAIDs on the heart that came to light because of the Vioxx trials, is likely much, much higher.  Most deaths from this class of drugs are from bleeding ulcers.  I’m not even sure we’re counting the cardiovascular deaths.

This particular study illuminates why these numbers may be so high.  Researchers looked at patients who were given prescriptions for an NSAID.  Of these, 86.6% were at increased GI risk and 72.7% for heart disease.  The patients’ individual risk had no bearing on getting the prescription.

Wow.  I always find this in stark contrast to the opinion that chiropractic care is “unsafe” or someone doesn’t “believe” in chiropractic care (didn’t know it was a religion…).  Instead of a referral to a chiropractor, many PCPs will give a prescription for NSAIDs, unaware of the high risks associated with this class of drugs.  Think of this next time you crack open that bottle of ibuprofen for your headache…

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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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Can Antibiotics Lead to Ulcers? The H. pylori Story

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ANTIBIOTICS LEAD TO ULCERS??  This is not a normal association in allopathic medicine, but if you follow the physiology it makes tremendous sense.  The bottom line is that antibiotics decimate our normal, protective flora whether it is in the back of the throat, small intestine, vaginal vault, large intestine or even in the stomach.  We have seen studies where lower levels of lactobacillus lead to higher levels of H. pylori.  This is another study (albeit an animal study) that demonstrates the link between low levels of protective flora and higher levels of H. pylori.  The ironic thing is that H. pylori is treated with a triple course of antibiotics, which is likely how it got there in the first place!!

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.

 

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…

 

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