Archive for the ‘Digestive Health’ Category

Proton Pump Inhibitors and Fractures

June 19th, 2010

Proton Pump Inhibitors, Prilosec, Nexium, Prevacid

On May 25, 2010, the FDA issued a warning to consumers that high doses or long-term use of proton pump inhibitors may increase the risk of fractures of the wrist, hip or spine.  Proton inhibitors are drugs that suppress the secretion of stomach acid and are used in the treatment of peptic ulcers, acid reflux, frequent heartburn, and associated conditions. I could say, “I told you so.” In fact, I probably just did. In any case, it’s good to see the FDA catching up with common sense.

Proton pump inhibitors are sold both over-the-counter and by prescription. Prescription varieties include esomeprazole (Nexium), dexlansoprazole (Dexilant), omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex). Over-the-counter varieties include omeprazole (Prilosec OTC, Zegerid OTC) and lansoprazole (Prevacid 24HR). According to Dr. Joyce Kovak, FDA’s Division of Gastroenterology Products Deputy Director for Safety, “Epidemiology studies suggest a possible increased risk of bone fractures with the use of proton pump inhibitors for one year or longer, or at high doses. Because these products are used by a great number of people, it’s important for the public to be aware of this possible increased risk and, when prescribing proton pump inhibitors, health care professionals should consider whether a lower dose or shorter duration of therapy would adequately treat the patient’s condition.”

The increased risk of fracture is no trifle. In a University of Washington study, pharmacologist Shelly L. Gray and colleagues followed 130,487 women over an average of eight years. They found a 25 percent increased risk of fracture among these women. 

As I’ve written before, by suppressing the secretion of stomach acid, proton pump inhibitors reduce the body’s ability to absorb minerals. Stomach acid — specifically, hydrochloric acid (HCL) — plays a critical role in separating minerals from the foods that bind them. Unfortunately, supplements don’t compensate for those lost minerals, because low HCL levels allow the minerals to combine with other substances, and so they become more difficult for the body to absorb. Low HCL levels particularly inhibit the absorption of iron, zinc, and calcium, making deficiencies a highly likely outcome of long-term proton inhibitor use. 

But this is hardly news. A 2009 study showed a number of “unexpected consequences” of proton pump inhibitor use. In addition to increased risk of fracture, the study pointed to altered B-12 and iron absorption, increased odds of contracting pneumonia, and increased odds of C. difficile infection. These potential consequences add up to a high price to pay — considering that there are equally effective natural alternatives.

The C. difficile infection issue is telling. You might be familiar with C. difficile as the culprit in the sometimes deadly infections that have accompanied the use of antibiotics. A bacterium that is normally found in the body, C. difficile is usually kept under control by gut flora and normal levels of HCL in the stomach. But under conditions of low stomach acid, this harmful bacterium thrives and can create dangerous infections. C. difficile causes severe diarrhea, is hard to treat, and again, can cause fatal complications. A Beth Israel Deaconess Hospital study conducted in Boston looked at more than 100,000 patients discharged from the hospital over five-year period. The study found that among these patients, infections with the C. difficile bacterium increased by 366 percent as doses of proton inhibitors increased. At the Boston Medical Center, another study of 1,166 patients being treated for C. difficile infections found a 36 percent risk of recurrence of the infection among patients taking proton pump inhibitors.

The real problem is that proton pump inhibitors do what so many other drugs do: suppress symptoms rather than address the actual causes of the condition. Mess with the balance of the body and you get symptomatic relief along with a host of other, perhaps far worse, problems.

So what’s an acid reflux sufferer to do? Fortunately there are effective, natural alternatives.

  • You can supplement with a good digestive enzyme formula to reduce the need for stomach acid.
  • Take a teaspoon of apple cider vinegar mixed with water and a little honey at each meal.
  • Drink less with your meals. Fluids dilute stomach acid, which triggers the stomach to produce more to compensate.
  • Eat less at one time. This allows the body to digest your meal with lower levels of stomach acid required.

But to really understand the issue of proton pump inhibitors and stomach physiology, check out Your Stomach, Part 3.

:hc

Stress Makes the Belly Ache: Health Blog

November 14th, 2009

Stress, Digestive Health

The expression “stop bellyaching” tells a lot about how stress affects the body. For many people, when problems attack, so does a stomach ache.  Certainly it’s no surprise that tension messes up the gut, but the degree to which it creates serious gastrointestinal issues might surprise you.

A recent study out of Stony Brook University Medical Center in New York evaluated 697 patients who had helped clean up after the events of 9/11. Four to five years after the cleanup, 41% had gastroesophageal reflux disease (GERD), compared with about 20% of the general population. GERD occurs when stomach acid or bile backs up into the esophagus, causing chronic heartburn and acid reflux. It’s an uncomfortable condition at best; debilitating at its worst, sometimes driving victims to surgery.

It’s noteworthy that even without an obvious triggering trauma, one out of every five adults in the general population has the disease. That’s a huge percentage, but not surprising given that obesity often links to GERD and so many people count among the obese. It’s also relevant that exposure to acute trauma such as that experienced by people cleaning up human remains at the World Trade Center site not only doubled the incidence of GERD, but also caused gastrointestinal symptoms that persisted for years (and that still persist, the research shows).

The researchers found that length of time at the cleanup site correlated with risk of GERD — the longer the exposure to the site, the greater the likelihood that the person developed gastrointestinal disease. No correlation was found to obesity among the cleanup workers. The researchers attribute this phenomenon to stress — not to environmental toxins.

Not surprisingly, many of the 9/11 cleanup workers suffer from continuing psychological problems, and the researchers found that such problems correlate to GERD. Five years after the cleanup, 21% of those with GERD had post-traumatic stress disorder (PTSD), 21.5% were clinically depressed, and nearly 30% had anxiety disorder. Two years later (seven years after the trauma), the numbers of those with both GERD and mental health problems actually went up. By 2008, almost 33 percent of the GERD sufferers reported depression. In fact, having several mental health disorders — for instance, both anxiety and depression — made the risk of GERD among the 9/11 workers almost inescapable. Among those with both depression and anxiety, 64 percent had GERD. Add PTSD into the mix, and that rate goes up to almost 70 percent.

It seems counterintuitive that as the years since 9/11 have passed and the traumatic events have become more distant, those originally exposed to the trauma have experienced an increase rather than a decrease in associated gastrointestinal and mental health symptoms. So much for the “time heals all wounds” theory. The explanation might be that untreated grief and trauma don’t disappear with time, but rather, simmer beneath the surface, creating a snowball effect. In any event, the researchers suggest that treating mental health issues may be key to resolving the gastrointestinal health issues.

As Dr. Douglas Brand, one of the researchers involved in analyzing the study data, says, “Eight years after 9/11 we are still realizing the aftereffects on those who responded and participated in the massive cleanup efforts. Shortly after this highly stressful and toxic exposure, the appearance of GERD characterized by high comorbidity [the addition of one or more disorders in addition to the GERD] with mental health disorders, but no relation to obesity or smoking, suggests that mental health disorders may play an important role in the persistence of GERD among these workers. Thus, treatment of the underlying mental health disorder may be necessary to resolve the physical manifestation of GERD.”

Hopefully the experts will take to heart evidence that counseling needs to be given to those exposed to trauma at the time of the exposure — even if the victims of that exposure seem functional — rather than letting trauma reactions (and concomitant physical symptoms) develop over the ensuing years.

Meanwhile, a simultaneous study found another reason that high-stress environments induce bellyaches. Dr. Mark Riddle of the Naval Medical Research Center in Bethesda, Maryland, studied the impact of infectious gastroenteritis among military personnel on the subsequent development of long-term gastrointestinal diseases including irritable bowel syndrome. Infectious gastroenteritis includes such conditions as diarrhea and dysentery, commonly contracted by people traveling and living in stressful situations.

When we deploy overseas, one of the biggest risks is infectious gastrointestinal disorders,” Dr. Riddle said. “By six months, troops will usually have one or more episodes of infectious gastroenteritis.” Doctors typically prescribe antibiotics to wipe out the causative bacteria and end the acute episode, but this study found that once infected, the victim may suffer far-reaching and long-lasting consequences far beyond the run-of-the-mill dysentery bout. Those who had experienced even one incident of infectious gastroenteritis were at six times the risk for subsequent functional diarrhea, and at four times the risk for irritable bowel syndrome.

The researchers point to the continued stress that troops remain subject to as a triggering factor in developing gastrointestinal diseases once a vulnerability has been established through prior infection. Dr. Riddle also notes that the vulnerability may be related to changes in “gut microbiota or neural symptoms related to the gastrointestinal tract.”

In other words, though the antibiotics may take care of the infection, something is messing up the gut bacteria. Reading between the lines, it looks like all fingers point to the antibiotics doing long-term damage, stress or no stress. (Once again, as I always point out, after exposure to antibiotics, you need to supplement with a good probiotic formula to rebuild populations of beneficial bacteria.)

Considering the vulnerability of the gastrointestinal system to stressors both environmental and psychological, we can only hope that the experts get smart and start distributing mental health care to those exposed to trauma, as well as supplements that replenish gut flora and education about how to protect and revitalize the bowels. And as for GERD/Acid Reflux, you might want to read up on exactly how it manifests in your intestinal tract and the various natural health approaches you can use to overcome it. I’ve covered this extensively, in my newsletter series on the intestinal tract, but if you just want to cut to the chase and jump right in, you can start with Your Stomach, Part 3.

:hc

Ten Sickening Foods: Health Blog

October 15th, 2009

Food Borne Illness

The Center for Science in the Public Interest (CSPI) has just released a report listing the 10 foods most likely to make you sick — or so the report claims. Leafy greens (a frequent source of salmonella, E. coli, and norovirus) take position number one, a fact that the media has latched onto by sporting headlines such as “Ten Healthy Foods Can Make You Sick.” While the sentiment does have a certain intrigue, it’s misguided on several accounts.

First, the 10 foods on the list certainly don’t all fall into that “healthy” a group. Ice-cream holds position number seven, cheese number five, and mercury-laden tuna number three. Even more to the point, though, the emphasis on greens as public-food-enemy #1 misses the fact that the study didn’t include poultry, beef, and pork. A closer look reveals that the report focuses only on foods regulated by the FDA, and meat products fall under the jurisdiction of the USDA instead. That’s a problem if you’re actually looking for an honest top ten list, because poultry, beef, pork, and egg products sicken a whole lot more people every year than do salads — which, sadly, also sicken plenty.

Since 1990, leafy greens, including lettuce, spinach, kale, and so on, have caused 352 outbreaks and 13,600 individual cases of food-borne illness. The most severe, recent, and widespread outbreak was caused by E. coli-tainted spinach, which sickened 200 people in 26 states in 2006, and left three dead. After that incident, growers nationwide vowed to clean up their acts, but by August of 2009, regulators found 1715 cartons of spinach that tested positive for salmonella, prompting a 12-state recall.

What makes leafy greens so problematic? First, they grow close to the ground, where they can come into contact with contaminated soil and water runoff. As Craig Hedberg, a professor at the University of Minnesota School of Public Health says, “These items are grown outdoors in fields with dirt. It’s probably impossible to grow them without contact with a food-borne pathogen.” Now there’s a concept to inspire an arugula salad for lunch.

Then, so much salad gets pre-bagged these days, and many analysts blame the processing for the problems. If one tainted head of lettuce gets chopped in the processing bin, it typically gets distributed into hundreds of bags of prepared salad, and all the ingredients that come into contact with it will also be contaminated. In fact, the incidence of food-borne illness related to greens has risen with the advent of “convenience salads.”

The other items on the “Top 10″ list are eggs (11,163 illnesses since 1990), tuna (2,341 illnesses), oysters (3,409 illnesses), potatoes (3,659), cheese (2,761), ice-cream (2,594), tomatoes (3,292), sprouts (2,022), and berries (3,397). Not surprisingly, following the announcement of the report, the various named food contingents leapt into the fray.

Apparently, the Produce Marketing Association, the American Blue Fin Tuna Association, and the National Milk Producers Federation “are outraged.” The National Milk Producers Federation issued a statement discounting the study, claiming it relies on outdated information. And, a spokesperson for the US Potato Board said, “Potatoes are inherently healthy and are not an inherently risky food and they should not be on this list at all, the issue is cross-examination and not potato itself [sic].” Huh? Even if you buy the contention that potatoes aren’t risky despite the statistics, you might wonder if eating them confers a Mr. Potato-Head IQ based on such twisted logic…and grammar.

“On a relative scale our food supply remains quite safe, says Dr. Hedberg. His cohorts point to the fact that there’s “only” one illness reported for every 3,000 to 4,000 meals. But if that’s true, and if you consider that for every “reported” meal three or five or a dozen others might go unreported, the odds of eventually getting food poisoning or some more destructive food-borne illness are actually quite high. At three meals a day, you eat 1,000 meals a year, so according to the odds (as reported), you should get sick from your food every three to four years at the least.

But lest you fear your lettuce, here are a few facts that should give some perspective. Government statistics cite 76 million cases of food-borne illness annually, causing 325,000 hospitalizations and 5,000 deaths. Out of those 76 million illnesses, remember only 13,000 were caused by greens, and that was over a 16-year time span. In fact, all the items on the Top 10 list added together caused fewer than 50,000 illnesses over that 16-year time span.

So what’s causing the 75.9 million other illnesses?

Beef, chicken, and pork, of course!!! The very items left off of the Top 10 list. The fact is that meat products cause 75 million percent more illnesses than produce does. Your odds of getting sick from lettuce or ice-cream or from potatoes are slim indeed compared to eating meat (Mr. Potato-Head is vindicated).

This doesn’t mean you should be cavalier. Contaminated produce does exist, and it could end up on your plate, though it isn’t likely. Your safest bet is to avoid beef, pork, and chicken as much as possible, and grow your own vegetables. But short of that, get fresh vegetables instead of the bagged stuff. Wash all produce very carefully; keep perishables refrigerated; cook eggs thoroughly; and keep a supply of a good colon detoxifier on hand to give you relief and purify your intestines just in case you do get food poisoning.

:hc

Probiotics, Body Fat, and Clinical Studies: Health Blog

May 14th, 2009

Probiotics

I am always ranting about the questionable value of clinical studies. True, I often cite them in my blogs and newsletters, but often, more as launching points for discussion than for their actual value. I know clinical studies are the sine qua non of medicine, and that people often challenge alternative medicine chanting, "Where are the clinical studies? Where are the clinical studies" But I believe that long-term anecdotal evidence is worth at least as much as a clinical study — especially when you repeatedly get two studies to authoritatively come to the exact opposite conclusion. Case in point.

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Wiping Out H. Pylori Can Backfire: Health Blog

August 28th, 2008

Immune System Health

It makes perfect sense to wipe out bacteria that cause cancer and other nasty diseases, right? According to Martin Blaser, an NYU School of Medicine microbiologist, it ain’t necessarily so. In fact, Blaser implicates the dwindling population of a bacterium called H. pylori, which can trigger stomach ulcers and gastric cancer, for causing conditions equally as dire. For one thing, he thinks that as H. pylori disappears, obesity rates go up. He also believes that the disappearance of the pathogen may be leading to more cases of esophageal cancer and childhood asthma.

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Contaminated Beef and the FDA: Health Blog

July 17th, 2008

Disease Prevention

People have been dying from contaminated meat for years. The latest incident seems to have prodded the USDA into making a feeble gesture towards helping consumers figure out how to avoid inadvertently buying problematic meat. In a policy-shift last week, the USDA announced that it will start posting the names of retailers that carry contaminated meat and poultry that’s subject to recall. This decision comes many months after the release of the “downer cows being tortured on the way to slaughter” video that led to the recall of hundreds of millions of pounds of beef, and a week or so after the recall of 5.3 million pounds of E-coli contaminated beef that sickened at least 40 people in the Midwest.

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Tomatoes, Salmonella, and Sewage: Health Blog

June 16th, 2008

Tomatoes, Salmonella, Sewage

With consumers nationwide toppling over from eating tainted tomatoes, the media has focused on the question of where in the world the salmonella-infected tomatoes come from. It seems that all the167 cases of salmonella that have so far surfaced bear the same genetic fingerprint, indicating a common point of origin — and right now, all fingers point toward Mexico. Not to California, Guatemala, North Carolina, nor Hawaii, nor to other places that distribute tomatoes here — and that’s causing much agitation among Mexican growers.

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Food Allergies, Allergen Build Up: Health Blog

March 16th, 2007

It is very common for people to automatically assume that a food allergy is directly triggered by food. However, this is not always the case. As discussed in my newsletter on allergies, they are the result of a cumulative build up of allergens in the body. To explain, there are over 100,000 new chemical additives and xenoestrogens that have been added to the environment in the last 50 years alone that could have made their way into your food and water supply–all taxing the body and contributing to any allergy problems. Also, any number of vitamin and mineral deficiencies can contribute to the problem.

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Test Your Stomach Acid: Health Blog

March 13th, 2007

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After my recent newsletter about the common myths of Stomach Acid, we have had a few people ask about how to test for low stomach acid. There are actually several options. The Heidelberg Gastric Analysis test is considered one of the most accurate tests. However, it’s fairly expensive (approximately $700).

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