To Your Good Health
Drugs that battle reflux carry significant risks
Q: I have been taking 40 milligrams per day of omeprazole for several years to control gastroesophageal reflux disease. My doctor had increased this from 20 mg when the low dosage was no longer working for me.
Lately, I have heard about the risk of significant side effects from this class of drugs (proton pump inhibitors), including adverse bone-density effects. I have tried getting off the drug, but, each time I try, I begin to experience intolerable acid-reflux problems almost immediately.
I have heard about several ways to wean oneself, including the use of aloe-vera extract, cider vinegar and so forth. What do you recommend?
A: I agree with you completely that many people use omeprazole and similar drugs unnecessarily. Most people use the medications because of symptoms of heartburn and presumed reflux. The medications are effective, but they have side effects. Three of them are electrolyte (salt and water) abnormalities, loss of bone strength and increased risk of pneumonia.
- The drugs probably shouldn’t be a first-line therapy. Lifestyle changes, such as abstinence from tobacco and alcohol, not eating three hours before bed, elevation of the head of the bed and weight loss in overweight people should be tried before medication, unless the symptoms are severe.
Antacids and H2 blockers, such as ranitidine (Zantac) or famotidine (Pepcid), can be used as needed.
If symptoms persist, an eight-week course of treatment with Prilosec or related medication can be tried. If someone needs repeated courses of PPIs, it is time to consider taking a look in the stomach with an endoscopy.
For people who have been on proton pump inhibitors long-term, I recommend slowly tapering off for two to three weeks. Although some people claim a benefit, I haven’t seen good evidence that cider vinegar or aloe-vera extract helps ease reflux disease, and I don’t recommend either.
Q: The medical advice is to reduce sugar consumption. Does this apply to 100 percent fruit juices, fresh fruit, sweetened cereal products or other fruit-sweetened products?
A: I think it makes sense to limit sugar intake, as most North Americans take in remarkably large quantities of it.
I do make an exception for fruits, as the body processes natural sugars from fruit differently.
You can try this out at home by eating four medium-sized oranges or drinking their equivalent in an 8-ounce glass of orange juice.
I think you will find a big difference in how full you feel.
Although reducing sugar is critical for diabetics and is important for anyone trying to lose weight — even for people with no sugar or weight problems — the evidence is accumulating that eating too much added sugar increases the risk of heart disease and diabetes.
Dr. Roach answers letters only in his North America Syndicate column but provides an order form of available health newsletters. Write him at P.O. Box 536475, Orlando, FL 32853-6475; or ToYourGoodHealth @med.cornell.edu
It has been a type of satisfying pleasure in responding to these “To Your Health” postings which come to my local paper weekly and I used to make more effort to respond. But as has become apparent, my output is kinda diminished in quantity as I try to maintain a certain ‘balance.’ Won’t speak on subjects I don’t fully grasp or, alternatively, have no interest or familiarity with. Furthermore, my preference is to detail what I have discovered regarding ordinary maladies which are common to most of us and since I am not partial to “specialties,” even that of ‘geriatrics’ (go figure),. . .when I do respond, it is because I believe a more natural, body-friendly and side-effect-free potential exists.
This is not to suggest anything other than a divergence of opinion to which all are entitled. This is what I have attempted to show through several physicians who have manned this “To Your Good Health” boat, starting with Dr Donohue. However, I very much enjoy Dr Roach’s handling of answers to his querants. He listens, is open and respectful, has an extensive, broad perspective. As an allopath, he may be as good as it gets. Even so, I do have something to add:
Q #1: The doctor’s response which I’ve bulleted can be generally useful, but describes an attempt to treat symptoms as he outlines traditional thinking as taught in BIG PhRMA’s schools. . . chemicals to solve organic ills. Then goes on to respond to her questions regarding both aloe vera extract and apple cider vinegar to which he claims not to have seen any evidence of help in dealing with reflux disease. I would agree with his observation; however, these would probably have been suggested to her for relieving the pain and distress she was experiencing in her stomach for which they are well suited and helpful. . .but not to “cure” her reflux disease
This is an extremely common and ordinary condition which apparently is little understood within the medical establishment as seen by the multitudinous prescriptions and treatments given to millions of sufferers. It ain’t workin’ because people don’t get better. . . what is wrong is not being addressed; it is actually being made worse.
The problem is too little stomach acid (“Hypochlorhydria”)
This can result from various causes such as food allergy, viral infection, over-indulgence from alcohol and/or auto-immune diseases. Most often, it is an inevitable result from getting older, which are the main causes of poor digestion and assimilation — referred to as low-stomach acid. The older we get, the more likely we are to develop these problems.. . which if left untreated, cascades into many more serious systemic problems, all because when one’s stomach doesn’t produce enough acid, food can’t be broken down properly and our food’s nutrient and mineral content will not be normal. Health will deteriorate in many ways. We slowly break the body down from mal-nourishment — no matter what we eat, even if it is the best organic stuff around.
This is not the latest news, hot off the presses. Indeed, back in the 1930’s, Mayo Clinic researchers did research and analysis (by intubation) on people by every age classification except children and those over 90. They found that teenagers rarely had sub-optimal stomach acid production; by the time we are 60, there is an approximate 50-/50 chance of having developed this problem. As for me, I was still able to eat anything without the least problem till late in my 70’s. But since then, I enhance my digestion with enzymes and the Betaine HCI and Pepsin Dr J. Wright’s covers in his generous writings via newsletter and books. His book on this subject is called “Why Stomach Acid is Good for You.”
I remember reading an article called the Hidden cause of nighttime leg Cramps a few years ago. He built a very logical case on just this – low stomach acid and the inability to assimilate the minerals one so desperately needs to keep the body humming along — as he pointed out, without normal stomach acid, neither calcium nor magnesium can be optimally absorbed (as with so much else). That’s important, isn’t it?
So this is the underlying cause, which needs to be understood for so many reasons and the stomach needs organic help, not chemical insult and further injury by crippling it trying to shut off the stomach acid as the cause. It needs MORE! As the pharmaceuticals shut down the stomach acid production, alterations in the intestinal microflora take place. The contents become too alkaline because of the loss of the stomach’s acid, and unfriendly microorganism can have a field day.
Dr Wright also warns the low stomach acid can also be triggered by low levels of pancreatic enzymes and by hidden gluten/gliadin sensitivity, so these are some of the things to think about and discuss with your doctor.
Q #2: Sorry, Here I must take a harder line than Dr Roach. Sugar is the #1 causative factor in so many problems. It is hiding in almost everything. Americans have a big time Sweet-Tooth, and it is destroying our health. Sugar is affecting even the Alzheimers progression which is now seen as Diabetes 3. Few people should be eating more than three pieces of fruit on a daily basis (if that much). Sugar shouldn’t even be brought into the house for anything. We have to retrain our selves ad our taste buds. We need some bitter in our palate — its healthy. If we could quit dairy and grains and learn to consume only wholesome, fresh, real, made at home food with as little cooking as possible;. . . simplify, simplify, simplify we probably wouldn’t have any health problems at all. And we would all be so svelte. . . . .Jan)