Thursday, November 11, 2010

Getting to the REAL cause...

11-11—a triggering of remembrance, a time to look around you and see what is really happening, and time to reflect. Time for me to start writing again!

Recently I have been thinking a lot about a common concern in our office—heartburn. Heartburn is a problem for so many Americans. The cause of the problem is a matter of opinion. Conventional medicine says that there is too much acid and the elimination of acid will help the burning sensation and other symptoms of indigestion such as bloating and flatulence. Often acid suppression is not an effective way to eliminate the problems and symptoms increase and often worsen. Medications like histamine blockers and proton pump inhibitors are very good at doing their job and eliminating acid in the stomach. But what is the result of this suppression? Why would we make this nasty acid stuff if it’s just going to cause our stomach to hurt?

Taking a look at my anatomy and physiology book from my first year of medical school, I learned that the lower esophageal sphincter (where the esophagus and stomach connect) NEEDS acid to close completely. Without sufficient acid, there is transient relaxation of the sphincter, allowing stomach contents to backwash into the esophagus. Using this line of reasoning, it seems that the problem to treat in cases of heartburn may actually be too LITTLE acid, rather than too much.

Acid is necessary for digestion! Without it, there is no breakdown and absorption of nutrients. It is often seen clinically that women with osteoporosis or osteopenia have a long history of using acid reducing medications. Calcium in food or supplements requires stomach acid to be absorbed as well as vitamin D. Taking Tums as a calcium source seems kind of pointless then—acid suppression and calcium all in one dose. Vitamin B12 specifically requires stomach acid to be absorbed as well. Malnutrition can result after long term use of acid reducing medications.

I saw a patient this week wanting to get off of her Nexium. This is not an easy thing to do. She called several times during the week in agony after slowly weaning the drug. We replaced her drug with a digestive enzyme, probiotics and amino acids and herbs to help heal the lining of her intestinal tract. After a week of pain, she finally felt better. Her sinus congestion, post nasal drip, headaches and constant cough went away, which are also symptoms associated with too little stomach acid.

As Thanksgiving nears and today we celebrate the hard work of our veterans, I think about the things that I am thankful for in my life. I am thankful to be continuing my education as a resident and to live in beautiful Wisconsin. I am blessed to have wonderful family and friends. I am thankful to live in America and for the men and women who serve our country. Most of all, I am thankful for my stomach that faithfully produces acid to keep me healthy and happy!

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