Podcast 30 - Acid Reflux: A Burning Issue

Transcription

Dr. Chad Edwards: This is Dr. Chad Edwards and you’re listening to podcast number 30 of Against the Grain.
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Dr. Edwards: Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered ‘yes’ to any of these questions, then we are the clinic for you. We offer Tulsa prolotherapy, P.R.P. or platelet-rich plasma therapy, and stem cell injections. I’ve nutritional therapies, bioidentical hormone replacement therapy and functional medicine to get you back on track to optimal health. Call our clinic at 918 935 3636 or visit our website www.revolutionhealth.org to schedule your appointment today.
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Announcer: Welcome to Against the Grain podcast with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready because we’re about to go Against the Grain.
Marshall Morris: Hello. Hello. My name is Marshall Morris and today I am joined by Dr. Chad Edwards who believes that 80% of medical recommendations are crap, technically speaking here. He is the author of Revolutionize Your Health with Customized Supplements and he served in the U.S. Army for 23 years as both an enlisted soldier and as an officer, as a physician. He graduated from the medical school at Oklahoma State University and he is the founder of revolutionhealth.org and Against the Grain podcast. Dr. Chad, thanks so much for joining us Tulsa prolotherapy.
Dr. Edwards: Marshall, thank you for being here and, man, you just do such a good job of introducing me. As always I’m like, “Who are you talking about?”
Marshall: Well, as the introduction speaker there’s very, very little upside to it and just a whole lot of downside for getting it wrong, so I feel like I made it through this one.
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Dr. Edwards: You did a great job as always. Today I thought we would talk about a topic that’s incredibly, incredibly common. This is something that I’ve actually dealt with in my past. It’s one of the reasons that I veered off and went more into a functional medicine realm, and I’ll tell that story in a minute. Today we’re going to talk about reflux, gastroesophageal reflux disease or acid heartburn kind of thing.
Marshall: Are we going to say that every time we need to reference it or what’s the deal?
Dr. Edwards: Gastroesophageal reflux disease? Yes, we will go a little bit over time, but I think it’s good.
[laughter]
Dr. Edwards: I’ll probably just say GERD
Marshall: GERD for short?
Dr. Edwards: Yes, GERD for short or reflux. This is something that is so common it affects 60 million people in America-
Marshall: Just in America?
Dr. Edwards: -just in America will have symptoms of reflux at least once a month. It’s an incredibly common condition and 25 million people will have symptoms on a daily basis. This is something that’s just really common and it can be a big problem for some people. There were 60 million prescriptions for reflux disease medications, so acid lowering prescriptions in 2004. This is an incredibly expensive disease process when you consider those numbers and how much each one of those prescriptions cost. In fact, 13 billion dollars, 13 billion dollars were spent on acid blocking or lowering medications in 2006. 5.1 billion dollars on Purple Pill, Nexium alone. 5.1 billion dollars. Could you use 5.1 billion dollars?
Marshall: I’ll tell you what? Let’s come up with the next Nexium and Mobium business here.
Dr. Edwards: I think that sounds like a great idea Tulsa prolotherapy.
Marshall: [laughs]
Dr. Edwards: I told you about – I’ve had a problem with reflux myself and I was in — I guess this could be a HIPAA compliant story.
Marshall: This is a HIPAA compliant story.
Announcer: HIPAA, Health Insurance Portability and Accountability Act.
Dr. Edwards: My story is, I was actually in residency and — I don’t know if anybody’s looked at me on the website or whatever, but I’m not technically obese. I could lose a couple of pounds and get in better shape, but I don’t qualify by definition. I’m not obese. But I was really stressed out. Residency was one of the most trying times in my life. I was just always, always, always at the hospital. I got a great experience, but I was always at the hospital. I remember running with a buddy. He lived right around the corner from me. He is a good friend of mine and we were running one night and I just are getting this reflux and I was like, “Man, that’s really uncomfortable.” This burning sensation in my in my chest and it was just like when you throw up a little bit in your mouth and you get that burning kind of taste. That’s what I felt and a lot of people when they have reflux that’s kind of what they will feel. Sometimes it’s more of a pressure, sometimes it’s — they feel like they swallowed a golf ball and it’s just kind of sitting there.
There’re lots of ways that this can present, but I remember getting that sensation and I was like, “Man, I can’t have that.” Now, of course, I was in family medicine residency, a traditional medical education. My patients, they come in and they have a problem and I had to give them a pill because that’s what you do, right? I had a problem, so I had to give myself a pill and I remember taking Zantac and “Cool. That took care of it.” Of course, the military got me my medications and all that good stuff, and I just needed it and just took it as needed. I discovered over a few months that that got worse and I was having more, and more, and more symptoms. I even started getting this thing where you, when you swallow, I felt like food was getting stuck a little bit right there. That wasn’t cool, so I got a — what’s called an EGD or an esophagogastroduodenoscopy; esophago, sorry. EGD is an upper GI which is a super easy procedure, a very, very low risk. They give you medicine and I remember they gave me the medicine in my IV, and I was like, “I think I’m going to [mumbles].” I was out. It was that that fast.
Marshall: [laughs]
Dr. Edwards: I got this procedure and, apparently, I’m a very fun drunk, because I guess I was pretty talkative.
[laughter]
Dr. Edwards: So they said, “Yes. You’ve got a little bit of esophagitis, a little bit of inflammation in your lower esophagus.” He prescribed a proton pump inhibitors or P.P.I. medication. I think AcipHex is the one they started with and I actually had some side effects with that medicine. I felt like I swallowed a golf ball when I took the medicine. If I didn’t take it, I didn’t feel like that, but the reflux was getting worse, so I took more and more medications which caused more and more — the golf ball became a baseball, and then it became a softball, and I was like, “This is ridiculous. I can’t handle this.” I switched back over to Zantac and that problem went away. Most patients that I’ve talked with haven’t had that kind of problem, but I did. The Zantac took care of my reflux and so I was on that for a while, and I got to a point where I was like, “Okay.”
I think I was 30 at the time, maybe 31, 32, somewhere there. I was like, “So I’m 33 years old. I’m not obese. I’m not in bad shape.” I ran quite a bit. I was in decent shape. My diet certainly could have been horrible, because I mostly ate in the hospital, but it could have been worse at the same time. I wasn’t doing drive through McDonalds every day, but why in the world does a 33 year old otherwise healthy male have reflux so bad he needs to take medications every day? That just didn’t make sense to me. Then, at one point, I switched over and started taking Prilosec or actually it was Omeprazole. So I started taking that one and I was actually tolerating that one okay at the time Tulsa prolotherapy.
When I got off active duty, I was still taking that medication and I remember I went to work for a large clinic in Tulsa. I remember one of the drug reps coming in. She was selling some of these acid blocking medications and she was saying, “Long term you want to be careful that you’re not getting magnesium deficient”, or she was showing me a thing on side effects for these proton pump inhibitors over time and they said you can get osteoporosis. You can get some other issues with long term use. Interestingly, these medications were never designed for long term use, but what I found is that a lot of my patients I just prescribe them and refill them all the time, and they’re on them for years, and years, and years, and years.
I was like, “What in the world? This is ridiculous.” It’s a very common condition that costs a whole lot of money and all we’re doing is just giving them pills, and we’re not making this problem go away. This just doesn’t make sense. I’m 30. I was a little bit older at that point, but I was like, “I don’t want to be on this medicine for the rest of my life.” This is something that could contribute to osteoporosis and it does that, because it interferes with the absorption of some of your minerals like magnesium, and zinc, and calcium, those kinds of things. You have to watch for deficiencies in those things and with those deficiencies it can lead to osteoporosis. I’m just like, “This doesn’t make sense. We want to fix this and not just mandate it.”
Marshall: And so what most doctors or the industry really will do, generally, is they will artificially correct the deficiency or the imbalance in the body and never really treat the underlying cause of this reflux in the first place Tulsa prolotherapy.
Dr. Edwards: That’s correct. In fact, basically what we’re doing is we’re suppressing the acid production in the stomach and that does treat the symptoms, but it doesn’t make the problem go away. That raises the question, “What is this reflux thing? What is reflux?” If you ask the average person, maybe it’s not fair. I didn’t do a poll, but what is — If somebody said, “I have acid reflux,” what is that?

Marshall: Maybe this is something completely different, but when I eat really spicy food and it gets my bubble guts going a little bit and maybe I get that, “Man, I shouldn’t have had that jalapeno enchilada,” and I get this burning sensation up and down my esophagus and you just, for me, it goes away after maybe 20, 30 minutes. But from what I’m understanding is people live with that on a day to day basis.

Dr. Edwards: Yes. Many people do.

Marshall: Okay.

Dr. Edwards: Many people do. Sometimes you can control it just by changing your diet, but what — Any idea what causes that?

Marshall: I would imagine just the stuff in your stomach getting into the esophagus.

Dr. Edwards: Yes. What most people I think would say is it’s too much stomach acid. You got a certain amount of stomach acid. These people have more stomach acid and it’s refluxing up into their esophagus. The problem with this is that’s not really a true statement. Someone with reflux doesn’t have more stomach acid. The problem is that they have acid in the wrong place. Your stomach is designed to hold stomach acid. You have a pH about two so it’s a really low pH, meaning it’s a very strong acid. It’s Hydrochloric Acid and your stomach is supposed to have that Tulsa prolotherapy.

The problem is when you have acid in the wrong place. The esophagus has a very different architecture and anatomical structure. The tissues are very, very different and you have this sphincter where there’s muscular valve that controls your food going down the esophagus and into the stomach. It’s called the Lower Esophageal Sphincter or the LES and you have this lower esophageal sphincter tone, and what happens is that that muscle will actually relax and allow food to reflux up into the lower portion of the esophagus or even in the upper portion of the esophagus, but that’s not — There’s more to it than that as well.

We are treating a condition that’s esophageal reflux, which is acid in the wrong place, by getting rid of stomach acid and I think it’s important to understand why we have stomach acid and some of the things that it does. It helps break down our food, so having that acidic content helps break down foods. That plays an important role in your digestion and your ability to absorb foods, and in the small intestinal bacterial balance, which is very, very important especially in this condition. We’re treating this inappropriately. Most people don’t have too much stomach acid. In fact, most people have not enough stomach acid which is really interesting. If you look at the studies, acid reflux or GERD increases in prevalence with age, but studies also show that acid production actually declines with age. It can’t be linear relationship between the amount of stomach acid and reflux. In fact, the opposite is true and that’s consistent with when we look at the physiologic levels of acid, and those kinds of things.

This is a condition where, generally, we’re dealing with not enough stomach acid instead of too much stomach acid. And then you have some pressure in your abdomen and those kinds of things that, if you had increased pressure on one side, you can’t get stuff to that side because there’s too much pressure. It’s like opening a door to a pressurized room. You got to push really hard to get that door open. When you push it open, you feel the rush of wind or something, so you want to consider why you have that increased abdominal pressure and what we found is that there’s [sic] a number of reasons why you can have increased abdominal pressure. One of them is just too much food. If you go to McDonalds and — “super-size me.” You look at the portions that we get in our meals and it’s just, it’s ridiculous sometimes the amount of food that we eat. Most of the time when I go out to eat, I can probably safely cut my meals in half, eat half of them at that time and take the other half home, and certainly that would be more efficient as well. I know, recently my wife and I went to — had the opportunity to go teach a class in Paris and the food portions there, across the board were not as quite as big as what we get here on average. It’s very interesting to see in that component itself. Most of us eat too much.

Then, when you have obesity, we talked about the fact that I wasn’t technically obese, you can deposit fat, adipose tissue all over your body and under your skin, but you can also have this called Visceral Adiposity and we probably should do a podcast on that one day. You’re basically depositing fat around your organs and interestingly, I was in the ER the other day and I had a patient that was morbidly obese, very, very large woman. When you looked at her CAT scan, you saw all of the subcutaneous fat which there was a significant amount but interestingly, you can see the wall of her abdomen bowing out quite a bit because of the fat that was inside her gut. You have all this fat that’s pushing her belly out. It also pushes your stomach up and so you have more pressure in there. Obesity is one of the things that can contribute to this gastroesophageal reflux disease. I did that whole thing just for you.

Marshall: Thank you. Thank you. I appreciate that.

Dr. Edwards: You’re welcome. Carbohydrate malabsorption is another condition and, when you look at your gut, I don’t remember how much we’ve talked about this in another podcast. We’ll definitely have more podcast on gut health, gut function, the bacterial balance, all of those kinds of things and when the bacteria balance is off, a whole bunch of problems can come about. One of them is that you can get real gassy and bloaty, and things like that. Not that gassy and the bloaty is just a bacterial imbalance. It could also be food intolerance or an enzyme deficiency, or something like that. Lots of things can do that, but you can get this gassy, bloaty thing and you can cause an overgrowth of certain bad bacteria because we’re not absorbing or we’re not digesting the carbohydrates. What you eat might be carbohydrate that’s seven or eight sugars long and it should be broken down, but it’s not. It’s almost a starchy kind of thing and the bacteria, it makes it all the way to the stomach and the bacteria feed on that and it allows them to overgrow. It causes a bacterial imbalance and then they overproduce gas, and now you have this bloated abdomen. It’s like a big, inflated balloon that also increases pressure. You can start compounding these problems.

And then, of course, a bacterial overgrowth itself can do that. I saw a patient this morning that he had a significant overgrowth of abnormal bacteria and he was actually on a very, very high quality probiotic, but somehow he got exposed to something that allowed this bacterial balance to get off and we got to kill the bad bacteria to allow the good bacteria to be reestablished, reestablishing that bacterial balance. Those are some things that can cause an increase in abdominal pressure and when we’re looking it, which we’ll talk about in a minute, after we come back from our break, and we’ll talk about what we can do about gastroesophageal reflux to help resolve certainly the symptoms, but also treat it from the underlying condition.

Marshall: Cool. Let’s take a quick break and when we’re back, we’ll get into it a little bit more.

Dr. Edwards: Awesome.

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Marshall: Okay. We are back. We’re talking about acid reflux or GERD. Okay, or GERD, so a lot of times when patients are looking to treat this acid reflux, they’re just taking pills to control the imbalance, okay? But really that doesn’t treat the underlying issue at play here which is some kind of maybe pressure or maybe something else is going on inside of them that is causing a heightened in pressure inside the abdomen. What can listeners or patients do that have these types of symptoms or experiences, what can they do alternatively to fix it?

Dr. Edwards: Sure. Of course, the traditional approach if you go to your doctor and say, “I’ve got some reflux,” the common thing is that they’re going to put them on acid lowering medication. Of course, you can go over the counter and buy Zantac or Pepcid, both of those are called H2 blockers and they lower the secretion of acid by a histamine mechanism. Now you can buy Prilosec, and Omeprazole, and all these things over the counter, but often your doctor may even prescribe a PPI, or proton pump inhibitor, and I’m not necessarily opposed to that on a short-term basis, especially if you have a symptom and we’re trying to figure out why is this reflux or is it something else, is there a different issue. So, sometimes I’ll say, “You know what, let’s go ahead and try a few weeks of an acid reducing medication and just use it as a diagnostic. Is this what’s really going on? So the Omeprazole, those kinds of things, do have some merit just, if nothing else, just in figuring out what’s going on. I don’t do that with everyone, but you can get some quick — especially if the patient is kind of unsure or not really sure if that’s what’s going on, you give them those medicines and it fixes their problem.

And one of the things that I see in the emergency room is they’ll come in with chest pain, and if we give them what we call a green lizard or a white lizard, there’s stomach medicines in that, and if it makes their problems go away, then we’d have a reasonable assurance that what we’re dealing with is a gastrointestinal stomach problem. You’ve got that as the traditional approach, but again, it’s just a band-aid. We’re just trying to figure out what’s going on and we’re trying to control the symptoms.
So from a more natural perspective we want to know what is — We want to fix the underlying cause. One of the things that I often recommend is a test that we actually have in my clinic. It’s called a Heidelberg test. The Heidelberg test is a radio frequency capsule that you swallow. You swallow this capsule and it will actually measure your stomach acid and it gives me the pH, so what we’ve found is that most of our patients actually have an inadequate amount of stomach acid, not too much. It’ll tell me exactly that. And we’ll actually do what’s called a bicarb challenge. We’ll give them bicarb, which neutralizes the acid, and we can watch the pH rise to about seven, and then, over about a 20 minute period, you should re-acidify. Your stomach should make new stomach acid and you’ll see the pH drop. And we do that a couple of few times and watch the pattern. If they don’t respond in a certain way, then they’re under-producing acid.
If you under-produce acid, you can’t break down your foods appropriately, food doesn’t get digested appropriately. It may not trigger the pyloric sphincter, so the stomach is actually kind of encapsulated if you’ll think about it, with a — you’ve got an inlet valve and an outlet valve. The inlet valve is that lower esophageal sphincter that connects the esophagus to the stomach that we’ve talked about a minute ago, and then you’ve got the pyloric sphincter which is the one allowing the stomach to open up and all the digestive contents or the stomach contents to go into the small intestine. But there are mechanisms by which that valve is triggered to open up and let the food go through. Well if the acid level is not at the right amount, sometimes we don’t trigger that pyloric sphincter appropriately, so the stomach just sits in there and kind of rots away, which is gross. And then you can get some additional reflux because of that. So the Heidelberg is a very, very interesting test and helps us understand what is it that’s really going on, and, of course, if we’ve got an acid production problem, then we want to figure out why and what can we do to treat that.
The next thing that we can do to help these symptoms is a low carb diet, so an Atkins type diet. There was actually a 2006 study that showed that a low carb diet decreases the acid exposure in the lower portion of the esophagus. The results of that were as effective as the proton pump inhibitor medications. So we’ve got this position where we’ve got studies that show it’s as effective as these medications, but it requires us to make a lifestyle change. Many patients don’t want to change. They want to eat their jalapeno enchilada and not have symptoms. “Well, doc, just give me a pill.” You know, if it’s a rare thing, okay, I’m not going to fight you on that one, but if it’s a daily thing, then there’re risks with those medications. It’s right there in the package insert for those medications or the sheet that the pharmacy gives you, if you’ll read through that, you’ll see all these side effects and all these things you have to watch for. And those are there because it’s been shown to cause those things. So we have to be very careful and we want to make sure we balance the risks and benefits of any intervention that we do. If we can treat the underlying cause, we don’t have to worry about the big picture. Low carb diet has actually been shown to be effective for this.
Digestive enzymes, if a patient doesn’t make enough of some of these digestive enzymes, many of them are produced by the pancreas. What I recommend is Xymozyme by Xymogen. A very, very high quality, very broad spectrum, it’s got a lot of really high quality digestive enzymes. In fact, if you think about Beano and Lactate — all of those are contained within that one digestive enzyme. So if you’ll take that around meals, it’ll help you to break down those foods more appropriately and if you break them down, then you don’t transmit those foods down low into the small intestine allowing an overgrowth of the wrong bacteria. So, digestive enzymes can be very important.
I find a lot of patients will benefit from apple cider vinegar. Which if you’re drinking apple cider vinegar, it tastes awful. But you can get apple cider vinegar capsules or you can just take hydrochloric acid, they actually make capsules and the one that I use, again by Xymogen. If you’ll go on my website and pull the book Revolutionize Your Health With Customized Supplements, I talk about Xymogen and why I like Xymogen because they are well controlled, they’re well-studied, we know exactly what’s in them, very, very high quality stuff. This stuff is not expensive. The one that I use is GastrAcid, kind of a play on words for the gastric acid and the getting enough of that acid in the stomach. Helps you break down the food, helps trigger the pyloric sphincter to open up. And what we find is that most patients benefit, especially when we look at that Heidelberg capsule and we find that most patients don’t have enough stomach acid. Replacing that can make their symptoms go away. And I actually saw that in my own reflux. I was able to, with an appropriate nutritional approach, eliminating junky foods, eating right foods, good clean whole foods, good fats, avoiding all the processed junk stuff, most of my symptoms went away. Then, when I added the hydrochloric acid, it pretty much resolved my reflux.
And the way we recommend taking the GastrAcid or the hydrochloric acid is start with one capsule with each meal, and do that for a day or two, a couple of days, and then after a couple of days increase it to two capsules, do that with each meal, then go to three capsules after a couple more days, then four. What we find is an improvement in symptoms and you want to increase that dose until you get a burning sensation in your chest, almost like that reflux. Once you get that sensation, take some sodium bicarb to neutralize that acid and then go back one capsule. So, if you get some burning sensation in your chest at five capsules, then cut it back to four. That’s your dose with each meal for the next 30 days. At the end of 30 days I usually start over, go one day without, then I’ll go with one capsule with each meal. What we find is that patients will actually decrease how much they need, and I can’t explain the mechanism, but again, they begin to kind of produce their own stomach acid on their own, without needing additional hydrochloric acid.
So it’s a great way to approach this and we see dramatic improvement in both symptoms and test results without worrying about malabsorption of magnesium and calcium, and all those things, and all the other problems that the proton pump inhibitors can cause.
Marshall: So, in recap, most people they might assume that acid reflux means an overproduction of acid from the stomach getting up into the esophagus. And today we’re learning that really if you look at the studies and just kind of the natural progression of the body, you produce less acid in the stomach as you grow older, and that’s where acid reflux begins to happen. In the studies that you’ve had, the patients that you’ve had, it’s actually a lack of acid that is causing some imbalance, and therefore creating this problem.
Dr. Edwards: Yes. Also because of the gut bacteria and the kind of foods we eat. So it’s not just age, but also the health of your gut in general. H. pylori can contribute to this, certain bacteria lives in your stomach, the stomach itself, not the small intestine, and then the bacterial balance also plays a role as well.
Marshall: So it’s a whole host of things that contribute to it. Rather than just treating the symptoms with a pill, you’ve given us a few things that we can do to actually treat the underlying cause of the problem.
Dr. Edwards: You got it.
Marshall: Bam. Thank you so much for joining us today and kind of shedding some light into this, maybe, misunderstanding but very prevalent problem across the entire country.
Dr. Edwards: Yes. It’s a burning issue.
Marshall: It’s a burning issue. Thanks so much, Dr. Chad.
Dr. Edwards: Thanks, Marshall.
Announcer: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week where we’ll be going Against the Grain.
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