now the long-term side effects are men potentially more significant and those include serious nutritional deficiencies one of the biggest ones is these drugs block the absorption of vitamin B12 vitamin B12 requires stomach acid to be absorbed and if you don't have it you're going to get B12 deficient over the long term that can create depression neurological problems dementia many many things welcome back to another episode of The Doctor's Pharmacy and health bites where we take juicy little bites into current health topics today's topic is acid reflux or heartburn as we used to call it it's a common but uncomfortable condition that affects about 10 to 20% of people in the western world and that's right in the western world because in countries where they don't eat crap it's not that common uh it's widespread it doesn't really make it normal right so what's the conventional view what's the conventional approach to treating reflux well conventional docs usually put their patients on anti- acid medication like proton pump inhibitors or histamine blockers H call H2 blockers like Zantac or tag proton pump inhibitors or ppis are one of the most commonly prescribed medications in the world it's I think third of all class medication after statins and psychiatric MTS and they're primarily used to treat acid reflux and stomach ulcers in systematic reviews of Trends and practices for the global use of these drugs ppis they found that in the research 25% of adults use them that's a lot of people now some of the most common are what I mentioned like prosac previsit Nexia as effects 63% of uh users of these ppis are under 65 37% are over 65 over half are 56% of PPI users are female and 25% of people who use these drugs are taking them for more than a year which is the problem and 28% take them for more than three years now then you're going to really get into trouble now many people are told they have to take them for life now heartburn is not a pyc deficiency I got news for you right now the reason why they're overused and overprescribed is because of our lifestyle and diet about 100 million prescriptions for ppis are dispensed every year up to 70% of people who take these drugs get no benefit from them so that's not so good so how do they work well these proton pump inhibitors or ppis are medications designed to reduce the production of stomach acid now they work by inhibiting what we call the hydrogen potassium atpa enzyme also known as the proton pump hydrogen is a proton okay so don't worry about all the technical medical jargon but there's the cells in your stomach called parietal cells that produce stomach acid and what these drugs do is they block the production of hydrochloric acid or stomach acid that's needed to actually digest your food and to maintain an acid environment in the stomach which is what you're supposed to have but if you block these Pathways this block the proton pump the stomach acid secretion is reduced a lot now what are the side effects of that well there's a lot of side effects from both the short-term and the long-term use of these drugs the short-term side effects include things like headaches nausea you might get diarrhea or constipation irritable bowel in fact you get heartburn traded for irritable bowel most of the time right abdominal pain and part of why that happens is you block the stomach acid and the food you're not digesting properly then it can ferment in the small bowel and then you get all these other secondary problems like overgrowth of bacteria overgrowth of yeast and it's just not good uh you might get abdominal pain you might get increased gas bloating dizziness skin rashes all kinds of stuff now the long-term side effects are men potentially more significant and those include serious nutritional deficiencies one of the biggest ones is these drugs block the absorption of vitamin B12 vitamin B12 requires stomach acid to be absorbed and if you don't have it you're going to get B12 deficient over the long term and that can create depression neurologic problems dementia many many things also it blocks mineral absorption like magnesium uh you're going to get low magnesium absorption and then what are the symptoms you can get muscle cramps muscle weakness you can get irregular heart beats palpitations constipation headaches I mean the whole list of magnesium deficiency symptoms they also impair the absorption of calcium and what does that do well that means you get less calcium protect your bones that increases the risk of hip fractures and osteoporosis so you take these drugs for your heartburn but then you end up with hip fracture and mortality from a hip fracture when you're older is 50% meaning at a year 50% of people have a hip fracture are going to be dead from that so it's not trivial it also increases the risk of infections particularly intestinal infections like cluster def AAL or C diff which is terrible I've had it you don't want it that bacteria grows when there's a higher pH or your stomach is less acidic and that makes this bacteria grow more and that can cause diarrhea can cause colitis also you can get pneumonia as I mentioned some studies show that high risks of community acquired pneumonia are prevalent in people who have uh regular use of these drugs these ppis because when you have low stomach acid maybe allows the bacteria to enter the respiratory tract you can get kidney problems you can get severe what we call gut dpos and this is one of the biggest challenges you're trating one gut problem for another gut problem right so you've got heartburn that might be short-term improved by using these drugs but longterm you get an imbalance in the whole microbiome and that causes all sorts of gastrointestinal issues like bloating diarrhea small intestinal bacterial overgrowth or sibo SEO or small intestinal fungal overgrowth and that's not good additional side effects may include the risk of dementia some Studies have indicated an association between long-term use of these drugs and an increased risk of Dementia in fact one study that was published in the Journal of Neurology found that people using these drugs for over four years were at a high risk of dementia compared to those who didn't use those drugs now it was an observational study it's not cause and effect more researchers needed but it's an interesting Association it makes sense to think about how it works because you're blocking the absorption of key vitamins like B12 which are important for cognitive function uh also there may be cardiovascular issues several large observational studies again not proving cause and effect found a a link with heart disease and long-term use a study of 1.8 million people found that use of these drugs elevated the risk of heart attack by about 20% the similar drugs the H2 blockers which are like tagat or Zantac didn't seem to increase the risk not sure what that would be but it's an interesting observation another study a cohort study of over 4,000 people found that those with greater than 5 years of cumulative exposure to the drugs had twice the risk of having heart disease and heart failure compared to non-users that's that's a significant number when you see an observational study with doubling of the risk you usually want to pay attention if it's like you know 10% or 20% or 30% but if it's 100% increased risk that that's concerning now potential mechanisms of how this might increase your risk of heart attack include depleting magnesium which can cause arrhythmias it can decrease the absorption of B12 calcium and iron it can interact with certain drugs like anti-platelet drugs cigil which potentially reduces their effectiveness um and some Studies have shown that there may be no increased risk for heart disease so we need more more data but I I think if you're at risk for heart disease you're on medications like blood thinners you want to be careful what about other side effects we talked about bone fractures and osteoporosis but long-term use of these drugs is linked to an increased risk of all sorts of fractures hip fractures spine fractures wrist fractures because you're not absorbing calcium and then you get osteoporosis what is the trick with these drugs when you stop them people go and I try to get off it I can't get off it because I get heartburn it's really bad so I'm stuck on it well yeah it's kind of addictive not in the traditional sense of addiction but what happens is you get this rebound hypers secretion of acid in other words the acid's super suppressed and then you stop the drug and then your stomach kicks in and just over secretes stomach acid so you kind of have to be careful as you cut down on these and do it slowly and so you can actually get worse reflex symptoms if you try to stop the drug but there's a way to get off it and we're going to talk you through it now what is the functional medicine approach to addressing heartburn I in fact wrote a whole textbook chapter on this but you know ppis are not the long-term solution in fact I spent a lot of my time getting people off of these drugs if you understand the root causes then you don't really need to actually take these drugs now I know I never get heartburn but if I'm bad and I'm traveling and whatever I eat a pizza or something once in a while which she has yes I do I'll go oh my God I got heartburn now it's just because I eat something that's not good for me that I get heartburn when I eat well I don't get heartburn and I think that's true for most people so what are the root causes let's go through them one of the causes is a weak lower esophageal sphincter the sphincter which is a little kind of tight muscle that keeps the esophagus uh at the top of the stomach tight so you don't get as pushing way up the esophagus becomes a little bit weak now there's a lot of reasons for that when when the when that muscle is weak or relaxes too much then acid escapes and that causes a reflux so what weakens this lower softage muscle first of all obesity or having a high body mass index if you're overweight it can put pressure on the stomach and if you're overweight you're more likely to get heartburn of course if you're pregnant also because you got this big baby pushing up that's going to cause heartburn but certain foods also cause a problem like chocolate alcohol caffeine peppermint essential oils carbonated drinks uh fatty foods also uh can relax a lower esophageal sphincter also hial hernia this is a common thing which is when part of the stomach kind of moves up in the chest that can lead to reflux uh and smoking also that can lower the tone of the sphincter at the top of your stomach that's in the esophagus so you can get reflux pregnancy as I mentioned hormonal changes occur but also just pressure on the stomach age um as you get older the lower esophageal sphincter actually weakens so you can get more reflux uh you also might get slowed gastric emptying for I reasons uh like goes empik which loves gastric emptying and you you know that can take too long to empty the stomach and you're more likely to have acid and stuff push back up the esophagus um I'm curious to I don't know if the data is out yet but it' be interesting to follow and see whether these gp1 Agonist actually cause more reflux now what causes delayed gastric emptying right so we talked about what's happening at the top of the stomach with the sphincter getting too loose and things kind of going up what about when things going go down right when you have sort of slow movement on the way down or delayed emptying of your stomach well high fat foods fatty foods fried foods for sure if I eat fried foods I'm going to heartburn large meals if you eat too much that'll cause a problem certain medications like anti-depressants can cause a problem opioids also are Narcotics block uh stomach function so they basically paralyze the bowel and you can get constipation that's why these drugs cause constipation alcohol also will have an effect on uh gastric emptying stress um will for sure slow your digestion because you've got the brain the gut and the gut brain and the Brain gut all connected and the body prioritizes fight ORF flight over rest and digest so when you're stressed your body's not digesting and when you're in a fight ORF flight State your body's producing about 80 to 90% L stomach acid uh if your thyroid is not working you know it's going to slow many body functions including your your digestion certain neurologic disorders muscle disorders like Parkinson's or Ms can affect digestion diabetes uh that can cause neuropathy which causes damage to the vagus nerve that nerve is important for regulating stomach function and intestinal function saliva production might be lower it's important to clear acid from the esophagus so people with reflux often have reduced saliva it's hard for their body to neutralize the acid so what causes lower saliva well lots of things dehydration aging mouth breathing low stomach acid now paradoxically uh not only High stomach acid can cause reflux but low stomach acid can also cause reflux symptoms or heartburn symptoms why because stomach acid is crucial for proper digestion when your levels are too low stomach acid the food isn't broken down and that can lead to digestive issues and reflux so the question is what causes lower stomach acid well getting older as you age you have produce less stomach acid chronic stress as we talked about poor diets if you had a lot of process foods refined sugars unhealthy fats all can lead to poor stomach acid production nutritional defici icies zinc vitamin B12 again lower lower stomach acid because of those and long-term use of an acids right whether it's proton pump inhibiters like ppis or H2 blockers mentioned those cause low stomach acid and they cause nutritional deficiencies that make the problem work so it's a vicious cycle now stomach acid is really important for digestion and the absorption of protein of vitamin B12 of magnesium calcium iron and zinc now you know plus other minerals so if your stomach acid is low you're going to get into trouble you can get deficiencies of all these nutrients if your stomach acid is too low um calcium magnesium deficiencies as we mentioned Leos prosis uh and that's a big concern now there's another reason sometimes that people get reflux or heartburn which is not because of what they're eating it's a bacteria called helicobactor pylori or H pylori which is common it interferes with the production of stomach acid and it can cause inflammation in the stomach lining it can cause ulcers and it's well known to cause ulcers in fact the treatment for ulcers used to be thought to be related to stress but actually it's this bacteria and taking antibiotics is the cure there was a scientist Barry Marshall from Australia who was a gastron neurologist who saw these bacteria in the stomach of people with ulcers and most GI docs just dismissed it as sort of insignificant but he thought it might be the cause so what he did was he swallowed a beaker of this bacteria gave himself s an ulcer and then cured it with antibiotics and then proved that the bacteria were causing the ulcers because the antibiotics cured his ulcer and then he won a Nobel Prize for that so they laughed at him first but then they then you got the double priz now what are the functional medicine approaches to solving the problem of acid reflux this is not a hard problem to solve if you know what to do the first step is you need to kind of relieve the symptoms so you have to reduce esophageal inflammation and you have to promote healing of the gut now there's a bunch of things you can take that help kind of Soo they got lining that are anti-inflammatory they are called demulant which sort of a compound that can help Soo the lining of the intestinal tract and they can be pretty pretty effective and the things that I tend to use are licorice root marshmallow root slippery elm bark all these things can be taken as herbs and they can be taken before meals or after meals as um or before bed and they're great as prevention they're most effective when taken in a powdered form or as a tea there are capsules for example deglycerized licorice or DGL is a form I use it's like Tums but natural Tums and you can take two or three tablets and chew them 10 15 minutes before meals uh you can get them online and we we offer them on the Dr hman store so you can go to drhyman.com and and see the brands that I recommend they're effective but um if you chew them they're they're better uh there are other anti-inflammatory phytochemicals that you can use aloe uh and one of my favorite MO is a aloe licorice glutamine combination and glutamine we'll talk about in a minute but glutamine is amino acid that can also help Soo the gut lining um but you can use aloe Ginger Arch choke Leaf curcumin in fact a recent trial found that curcumin was as effective as omisol which is pyc right a common proton pump inhibitor for treating symptoms of what we call functional dyspepsia which is basically indigestion including reflux uh taking a curcumin supplement with black pepper uh a form of black pepper called uh pepperine actually increases the absorption of curcumin and that can help as well the limine has shown promising results another compound from actually lemons that's shown benefit in early research um small trial 86% of subjects experience complete relief from reflux after 14 days using a th milligrams capsule every day for 5 days followed by one capsule every other day for 5 days compared to to just 29% of the placebo group so pretty big result uh the mechanism to action we don't really know but it could help coat the esophagus it could protect the underlying tissue from exposure to acid it could speed up gastric emptying other things that might be helpful are melatonin that may be effective it inhibits gasd acid secretion it increases gastron release now gastron is the hormone that helps prepare the digestive system and it also helps strengthen the lower ESOP sphincter which is making sure that you don't get food coming on the way up instead of going down uh and also melatonin seems to have an antioxidant and anti-inflammatory property as well now Studies have found that melatonin about 3 to 60 milligrams a day is as effective as 20 milligrams of aprol or prosc the main PPI in reducing reflux symptoms like heartburn or stomach pain so it seems like melatonin might offer similar symptomatic relief as the approach on pump inhibitors without the side effects of increased symptoms and various diseases like we talked about all right after you've some of these things what else can you do well you want to address your diet and lifestyle factors right obviously I've said this over and over but just eliminate Ultra processed foods dramatically reduce or cut out refined sugar and starches get rid of all the refined oils fried foods those are bad get rid of the triggers for reflux that are common that even traditional doctors recognize like alcohol coffee tomato spicy foods chocolate fatty foods Citrus Foods those may be a problem not to say that uh chocolate or coffee or tomatoes or Citrus are bad but for some people they maybe triggers you want to reduce those I would encourage you to do an Elimination Diet like the 10-day detox diet we're relaunching really soon it's an incredible approach to eating that helps feel so many problems including reflux you don't have to do it forever but you will see very quickly if what you're eating is causing the problem Dairy and gluten are the most common triggers uh you might want to check for celiac disease or gluten antibodies or non-celiac gluten sensitivity that can be a big factor and by the way at function Health we test for all of this you can look at function health.com Mark jump this weight list of 300,000 people now and you can learn about all your biomarkers including get testing for uh food sensitivities and uh gluten and celiac disease also you want to incorporate Whole nutrient-dense Foods in your diet as you would always with your highend fiber and good fats you want to focus on anti-inflammatory foods things like dark green leafy veggies healthy fats like avocado olive oil nuts and seeds uh good quality protein lots of colorful fruits and veggies you can have beans and Grains if you've done the tendy detox you want to add stuff back you can add those back in but try to start with non gluten grains to start I would also encourage you to eat a diet that helps your gut bacteria you've got to tend your inner garden and the best way to do that is eating fermented foods like sauerkraut and kimchi for gut health probiotics are also really important I recommend probiotics a lot eat uh smaller meals uh take your time while eating chew your food while eating maybe don't drink so much fluid while eating see how you do with that doesn't matter for everybody for some people it's a factor and and for sure don't eat before bed give yourself at least three hours between the last meal and bedtime so that wraps up today's episode on the root causes and solutions for reflux we've explored everything from the risk of relying on medications like ppis or acid blockers to how functional medicine could address the real underlying causes like poor gut health lifestyle triggers even low stomach acid now remember while it's easy to reach for quick fixes like taking the pill getting car is key to long-term relief and your overall health because longterm if you're taking these drugs you're going to get into trouble whether it's osteoporosis or vitamin deficiencies or pneumonia or worse like things like Ci now incorporating the right foods and focusing on your digestion managing stress using targeted supplements makes a huge difference in not just relieving symptoms but also healing the gut and the restoring balance overall in your body that's a process so with the right mindset and the tools you can actually get longterm relief from reflux so thanks again for joining me today and don't forget to rate review and follow the Doctor's Pharmacy wherever you get your podcast stay healthy stay informed and I'll catch you next Friday for another juicy episode of Health bites if you love that last video you're going to love the next one check it out here [Music]