Author Archives: Dr. Peter Knight

Are Dietary Supplements Sending People To The Emergency Room?

emergencyI routinely recommend the use of dietary supplements as part of my treatment plans with my patients.  Because of this my ears perked up when I heard a story on NPR a couple of weeks ago about the high number of people ending up in the ER due to adverse events related to dietary supplements. The story was about a study in the New England Journal of Medicine published on October 15th that found that an estimated 23000 emergency room visits each year were attributed to dietary supplements.

Now I am of the belief that it would be ideal to prevent any visit to the emergency room and so I was curious to look into the details of the study a little bit further.  23,000 sounds like a large number, but when you take into account that there are 136 million ER visits each year, this ends up being a very small percentage of total ER visits- .019% to be exact. To put this into perspective, 731,000 ER visits were associated with adverse events to the medical use of prescription drugs, 775,000 pediatric visits were for injuries associated with organized sports, 1.2 million visits were due to alcohol ingestion as the primary cause, and over 76,000 were for fire arm related injuries.

According to 2011 data 166 million Americans use dietary supplement and so there is only a .015% chance that someone taking a dietary supplement is going to end up in the ER because of an adverse event.   As I said, I feel that any preventable ER visit is too many, but taking dietary supplements seems like a relatively low risk behavior and not worthy of devoting the media attention to it that it has received.

Looking at the study even more closely, 20% of the visits were due to accidental ingestion by children under the age of 4. While this is a serious issue, it has nothing to do with the supplements themselves but instead has more to do with the childproofing of the home.  Of the close to 3000 visits that were attributed to those over the age of 65, over 60% were because of swallowing issues. Again this is a serious issue, but has less to do about the safety of the dietary supplements themselves.

This is not to say that there were no actual adverse events associated with supplements use. The products responsible for 42% of the total ER visits were supplements marketed for energy and weight loss. Many of these products contain stimulants and ingredients that are not really dietary supplements but instead should be classified as undeclared active pharmaceutical ingredients. While I agree that many of these supplements pose potential harm and should be taken off the market, the actual risk is still relatively low.

Just a Spoonful of Honey…

Camp 2013 025Last year, my wife and I began our latest hobby, beekeeping. Over the course of the summer our hives built up from fledgling colonies to robust pollinating and nectar collecting forces.  Despite getting our fair share of stings, by August we managed to harvest over 50 pounds of honey. This amount is staggering when you consider that it takes 12 bees their entire lives to produce 1 tsp of honey and that on average bees have to visit 2 million flowers to produce 1 pound of honey.  While 50 pounds sound like a lot, if all goes well, we may end up with four times that amount this year.   We have enjoyed eating and sharing our honey over the past nine months and have been constantly looking for new ways to use it in cooking.  While I think that honey is delicious, as a doctor I have been intrigued by the myriad of benefits it can have on our health as well.

While the rise in the interest in bees and beekeeping is a relatively new phenomenon, the use of honey as medicine is not. The Egyptians were using honey as medicine more than 4000 years ago and would put some in their burial chambers to take into the afterworld.  As a testament to its antimicrobial and antioxidant properties, samples of honey found in Egyptian tombs have been found to be perfectly preserved and still edible.

CSC_0125One of the prime ways that the Egyptians used honey was for dressing wounds.  Honey is still used for wound healing today and studies have backed up its effectiveness.  Honey acts a perfect wound dressing since it cleans the wound, acts as an antimicrobial, stimulates tissue regeneration and reduces inflammation.  Honey has been found to be useful in in a wide range of wounds including abrasions abscesses, bed sores, ulcers, surgical wounds, and burns.

In a time when pharmaceutical antimicrobials are becoming less effective against bacterial infections, honey has shown promise as antimicrobial agent inhibiting the growth of over 60 species of bacteria including MRSA. Unlike conventional antibiotics it does not appear that honey leads to the development of antibiotic resistant strains of bacteria.  Honey also does not seem to negatively affect our beneficial gut microbes and has even been shown to increase levels of Lactobacillus and Bifidobacteria.

Honey has other benefits for the gastrointestinal tract in addition to its impact on the microbiota.  Honey has been shown to speed the healing of gastric and duodenal ulcers and also to decrease inflammation of the stomach known as gastritis.  Use of diluted honey has been found to speed the recovery from cases of infectious diarrhea and gastroenteritis.  Taking a teaspoon of honey before meals has been found to decrease the incidence of heart burn or gastro esophageal reflux.

While the idea of pouring honey in your eye may sound strange, eye drops made from hone have been found to be helpful for various ophthalmological conditions including conjunctivitis, blepharitis, dry eyes, keratitis, corneal injuries and even chemical burns.

I typically recommend patients with increased cardiovascular risk and elevated cholesterol avoid sugar, but honey intake may actually decrease cardiovascular risk.  When natural honey was compared with artificial honey made of fructose and glucose, the natural honey was found to lower total cholesterol, LDL cholesterol, triglycerides, and CRP, a marker for inflammation.  In addition it caused a slight increase in the more beneficial HDL cholesterol.    Honey was also found to lower blood pressure and its high antioxidant content may further reduce cardiovascular disease risk.

Coughs in children can lead to sleepless nights for both the child and their parents.  A double blind placebo controlled study reported in the journal Pediatrics in 2012 may help give relief to children and their parents.   Children with night time coughs caused by an upper respiratory infection given a spoonful of honey before bed decreased coughing and improved sleep.  Just keep in mind not to use this remedy in children under 1 year of age as there is a small risk of botulism.

In addition to the properties that I have mentioned that have been studied, numerous anecdotal claims about honey’s healing properties exist.  One of the ones that I hear most frequently is the use of local honey to reduce the severity of seasonal allergies.  While studies looking at this effect have not been conclusive, my own experience has shown it to be beneficial.  When using honey for this use it is important for the honey to be as local as possible so that you are getting exposed to the pollens in your area.

a-jar-of-honeyWhen buying honey it is important to know that all honey is not the same and that much of what is sold as honey is actually not honey.  A study from 2011 found that 75% of what is sold as honey has actually had the pollen filtered out of it.  The removal of the pollen appears to decrease the beneficial properties of the honey and definitely decreases it effect on seasonal allergies.  When buying honey it is important to remember that you get what you pay for.  It was also found that inexpensive “honey” from China was actually honey diluted with high fructose corn syrup.

When you buy honey it is best to buy raw honey and the honey should say on it where it was collected.  If you are not able to find local raw honey in your grocery store, try looking at health food stores, farmers markets, or even stores devoted to the sale of honey, bee products and beekeeping supplies like Portland’s The Honey Exchange.  Owners Phil and Megan Gavin have a wide selection of local and non-local raw honeys and can tell you about where the honey comes from, what it tastes like and always have a number of delicious honeys available for sample.  You can also look inside their observation hive and see the bees in action.

For a refreshing thirst quenching summer time treat try this recipe for a honey rhubarb drink from Poland that combines that tang of rhubarb with the sweet floral taste of honey.

Polish Honey Rhubarb Drink

Adapted from a recipe by Barbara Rolekrhubarb cocktails

  • 4 cups water
  • 1/2 cup honey
  • 1 pound rhubarb, peeled if necessary, chopped
  • 3 cups hot water
  • Orange slice or mint for garnish

 

Bring 4 cups water to boil, remove from heat, stir in honey and let cool.

Whiz chopped rhubarb in a food processor. Place pulp in medium bowl, pour hot water over pulp and cover. When bowl is cool enough to handle, place in refrigerator for 2 hours or until cold.

Once cold, strain rhubarb pulp through a sieve into honey-water mixture. Stir. Pour over ice and garnish with either an orange slice or a mint leaf.

Can You Trust Your Supplements?

images35DGQ9E6If you are like more than 50% of Americans you took one or more dietary supplements today. The use of dietary supplements has been increasing over the past 20 years. What you once could only find in health food stores is now available in drug stores and grocery stores. It has even become common for conventionally trained medical doctors to recommend multivitamins, fish oil, probiotics and vitamin D. Most of the patients that I work with are taking multiple supplements before I start working with them.

While I recommend dietary supplements to many of my patients I do have concerns about the safety, interactions, and quality of dietary supplements. I will be addressing safety and interactions in future blogs, but in this blog I want to focus on quality issues with dietary supplements.

A recent quality evaluation by the company Consumer Labs found that 20% of the vitamin D products that they tested failed their quality testing. Two products contained almost twice as much vitamin D as was listed on the label, once product contained unacceptable levels of lead, and two products did not disintegrate within the expected 30 minutes. Trader Joe’s Calcium Citrate with Vitamin D contained 175% of the amount of vitamin D on the label and still had not disintegrated after an hour. So while you might save a little money on buying your calcium and vitamin D from Trader Joes, if it doesn’t break down in your digestive tract you might as well be throwing your money away.

In another evaluation they found that 16 of 42 multivitamins tested either had less of a nutrient or nutrients than the label stated, had more of a nutrient or nutrient than the label stated, or didn’t dissolve under normal circumstances. While the benefits of taking a multivitamin can be debated, if you are taking a multivitamin it would be good to know that it contains the amounts listed on the label and also that it is going to dissolve in your stomach as opposed to in the sewer.

Several years ago an analysis of Ayurvedic herbal products purchased from health food stores in the Boston area found that over 20% of them contained dangerous levels of lead, mercury, and arsenic. While the amounts in a single pill were not enough to cause a problem, if you were taking them every day for months, the toxic exposure could begin to have serious health consequences.

A study done at Bastyr University looking at the quality of probiotic supplements found that only one product out of twenty contained exactly what the label claimed it to contain.  30% of the products were contaminated with other organisms and 20% had no growth of any bacteria.

These examples unfortunately are just the tip of the iceberg. Other issues have included adulteration with anabolic steroids, high levels of toxic solvent residues, failure to contain the herb or probiotic species listed on the label, and inclusion of rancid oils.

While I have a great appreciation for dietary supplements, it has become clear to me that there is a great deal of variability in the quality of products sold as dietary supplements in the United States. While there has been an increased effort by the FDA to enforce basic quality standards, the supplement industry remains largely under regulated. The FDA does now require supplement companies to follow specific good manufacturing practices (GMP) in regards to the manufacturing of the product, but there is not the infrastructure to adequately enforce these and even if they did there is concern that the FDA standards may not be adequate enough to ensure that supplements are safe, free of contaminants and contain the substances that the label says that they do. The GMPs also don’t regulate the effectiveness of the product, the forms of the ingredients, where the herbs and nutraceuticals come from, or whether or not the additives or fillers used might have negative effects.

Fortunately there are some companies that have taken it upon themselves to make sure that they are producing high quality products. These companied not only follow the FDA regulations, they go beyond these standards to ensure that when you buy one of their products it contains the ingredients they say they do, in the amounts listed on the label and have been tested to make sure that they do not contain heavy metals, rancid oils, microbes, pesticide residues, solvents, or pharmaceutical drugs.

In order to find these companies, I have had any company that I recommend complete a detailed quality control survey so that I can tell if they meet the standards that I think are important to ensure that the supplements that I recommend to my patients are safe. In addition to the surveys I have sent out I have also had the students in the Supplementation and Whole Foods Nutrition course that I teach for the University of Western States send out the surveys as one of their assignments and so I have gotten to see a wide range of responses.

Based on those responses I have found several companies that I feel meet a high enough standard for me to recommend safely to my patients including: Thorne Research, Metagenics, Designs for Health, Integrative Therapeutics, Vital Nutrients, Biotics Research, Douglas Labs, and Pure Encapsulations.

Some of these companies can be found on the Order Supplements page of this website. In addition many of these can be purchased at Apothecary by Design in Portland and True North in Falmouth.

So the next time you are tempted to buy that cheap bottle of vitamins remember that you may be getting more (or far less) than you paid for! In my next blog I’ll take a look at some of the potentially dangerous interactions between dietary supplements and the medications that you may be taking.

 

Find the foods that are healthy for you.

4fFood sensitivities are a common occurrence affecting more than 35% of the population Food sensitivities can cause a wide range of symptoms including:

  • Weight gain
  • Heartburn
  • Constipation
  • Diarrhea
  • Low energy
  • Lack of focus
  • Irritability
  • Depression
  • Chronic congestion
  • Skin rashes
  • Poor sleep
  • Muscle aches
  • Joint pain

 

Unlike food allergies which cause immediate onset of symptoms, symptoms of food sensitivities can be delayed by hours or even days. The wide variety of symptoms and the delay in symptoms presentation can make it very hard to make a connection between the food and the reaction. Because of this, many people who suffer symptoms caused by food sensitivities don’t realize that a food is to blame.

Uncovering hidden food sensitivities can often be a difficult task. Lab tests used to test for food sensitivities can be costly and often unreliable. Elimination and challenge diets are the gold standard for diagnosing foods sensitivities, but they can often be hard to follow and if done incorrectly can be hard to interpret.

To help you to determine if any of your symptoms are being caused by adverse reactions to foods, I am offering a four week elimination diet class beginning on Tuesday April 29th. This class will help you to successfully undertake a comprehensive elimination diet, determine which foods are causing your symptoms, and learn how to potentially decrease your food reactions and prevent new ones from developing.

The four week group program cost $195 and includes:

  1. Elimination Diet Program Binder with the detailed, instructions, recipes, tips, resources and tracking tools needed to be successful with the program.
  2. Access to an Online Group for participants only, moderated by Dr. Knight.
  3. Four Group Sessions held on Tuesday evenings at my office at 222 Saint John Street in Portland from 6:30 to 8pm:
  • April 29th: Getting Started
  • May 6th: Strategies for Successful Elimination
  • May 13th: How to challenge.
  • May 20th: Discoveries and life beyond the program.

To register or for more information call (207) 805-1129 or email info@drpeterknight.com

You Are What You and the 100 Trillion Bacteria in Your Gut Eat

iStock_000014496302SmallWe have all heard the saying you are what you eat. While there is a lot of truth to that statement, it is becoming clear that it may need to be updated to “you are what you and your gut bacteria eat.” Research into the function of the 100 trillion bacteria that call our gastrointestinal tract home has been exploding over the past few years. We now know that they are not merely uninvited “house guests” but instead play active roles in our health as well as metabolic activity effecting our digestion, immune function, hormonal function and mood.

 

One area of research that has received much attention is the discovery that gut bacteria have an effect on the development of obesity, metabolic syndrome and type 2 diabetes. People with higher levels of bacteria in the Firmicutes family and lower levels of bacteria in the Bacteroidetes family seem to be more likely to be obese and are at an increased risk of developing diabetes and metabolic syndrome. The increased risk of diabetes and metabolic syndrome appears to not just be a result of the obesity, but instead is related to effects on inflammation and liver function. The increased weight gain is in part due to the fact that some bacteria in the Firmicutes family are very good at digesting starches and fibers that you can’t digest and converting them in to short chain fatty acids that the body can then use as energy. This ads to the net energy intake on a day to day basis and so you may be getting more “calories” out of your food than you think. The bacteria that do this are not pathogenic or “bad” bacteria. In fact some of them are strains of Lactobacillus bacteria usually thought of as being health promoting.

 

A study published in Biology Letters in January found that people living in northern climates, such as Maine, have higher levels of Firmicutes bacteria and lower levels of Bacteroidetes bacteria and that this correlates with the rates of obesity in the regions studied. From an evolutionary standpoint there is a benefit to this as an increase in energy production would increase the likelihood of survival through the cold harsh winter. Why this shift occurs is not known at this time. It may be that there is an environmental input such as temperature or amount of daylight that stimulates the growth of Firmicutes bacteria. It is known that dietary factors can have a large effect on the balance of Fimicutes and Bacteroidetes bacteria. A diet higher in fat and refined sugars will increase Firmicutes levels while a diet lower in fat and higher in plant polysaccharides (found in fruits, vegetables, legumes, and whole grains), will increase the levels of Bacteroidetes bacteria. In general there does tend to be an increase in fat and sugar intake during winter and a decrease in fresh vegetable intake the further away from summer that we get.

 

A big pharma approach to this (and I’m sure some drug company is working on this) would be to design an antibiotic that kills only the Firmicutes bacteria and spares that Bacteroidetes bacteria. While this could have short term benefits, in the long term many of the Fimicutes bacteria have benefits and getting rid of them could lead to increases in allergies, depression, and inflammatory bowel disease to name but a few.

 

A better approach would be to eat a diet lower in saturated fat and sugar and eat more plant foods. In addition,a study published in the journal Chemico-Biological Interactions showed that a high intake of poly-phenols found in green tea, apples, and cider or wine vinegar preferentially increase the levels of Bacteroidetes bacteria. While Lactobacillus bacteria can have many benefits, it may also not make sense to supplement with them when levels are already high. Focusing on probiotics higher in Bifidobacteria (a member of the Bacteroidetes family) along with prebiotics and colonic foods that increase their levels may be more beneficial and less likely to negatively impact the Fimicutes/ Bacteroidetes balance.

 

You can find out what your ratio of Firmicutes to Bacteroidetes bacteria is by doing stool test that looks not only at this ratio but also uses DNA markers to determine the levels of various bacteria in your gastrointestinal tract. Having this information can help in determining dietary changes that will be helpful along with determining if probiotics are necessary and if so what type. If you are interested in finding out more about this test, or if you would like to have the test done, you can call my office at (207) 805-1129 or email me at info@drpeterknight.com

The Road to Health is Paved with Good Intestines #6: The Large Intestine and Its Microbial Inhabitants.

iStock_000012048107Small-300x300In my last blog post, we made our way through the 22 feet of the small intestine. Once what has remained of our food completes that journey, it goes through a gate called the illeocecal valve and finds its way into the large intestine. The large intestine is only about 5 feet long but the diameter of the tube is quite a bit larger than that of the small intestine, thus its name.

By the time the food remains make it to the large intestine, our own digestion of it has completed. This does not mean that digestion is over though. The 5 pounds of bacteria that inhabit the large intestine are happy to feed upon whatever is left. They ferment carbohydrates that you were not able to digest and in doing so produce b-vitamins such as biotin, vitamin K, and short chain fatty acids that serve as an energy source not only for the cells of the intestine but for the rest of the body as well. Short chain fatty acids also help with the repair of cells in the large intestine and provide defense against colon cancer and inflammation in the large intestine. Read more »

The Road to Health is Paved with Good Intestines #5: The Small Intestine

iStock_000012048107Small-300x300When we last left the gastrointestinal tract we were in the stomach where stomach acid and enzymes in conjunction with the mechanical forces of the stomach’s muscles were breaking down our food into a liquid known as chyme. When the gate at the bottom of the stomach called the pyloric sphincter opens, the chyme leaves the stomach and begins travelling into the small intestine.

Despite its name, the small intestine is the longest part of the gastrointestinal tract with the average length of 22 feet. If this wasn’t big enough, if you were to pull it completely taught, the surface area would be the size of a tennis court. This is because the inner surface is shaped into a multitude of finger like projections called villi. When you look at it under a microscope it resembles the Down East coast of Maine. This giant surface area increases the nutrient absorption ability of the small intestine.

Before digestion and absorption can be completed more digestive enzymes and other chemicals are needed to continue breaking things down. Some of these enzymes are released directly by the cells of the lining of the small intestine. Others are released through a small connecting tube by the pancreas. Bile, released by the liver and stored in the gallbladder is squirted in to emulsify fats in a similar way to how dish detergent works to clean grease off of pans. Once the chyme is mixed is mixed with these enzymes and chemicals the carbohydrates, fats, proteins, vitamins, and minerals are then absorbed across the lining into the blood stream.

In addition to its functions of digestion and absorption, the small intestine houses 70% of your immune system and helps to distinguish between molecules you can absorb and friendly bacteria from non-digestible food particles and pathogenic organisms. More of your immune system is located in your gut than any organ in your body because it comes into contact with more foreign molecules and organisms than any other organ and the lining of the small intestine is only one cell thick.

When your gut immune system is working well it is able to handle the load that it is exposed to on a daily basis. However, a number of factors can cause it to become overwhelmed such as:

  • Eating food high in sugar and unhealthy fats
  • Eating a diet low in fiber
  • Incomplete digestion caused by low stomach acid or impaired digestive enzyme function.
  • Exposure to food allergens or environmental toxins
  • Excessive or chronic stress
  • Nutrient deficiencies
  • Viral, bacterial, or fungal infections.
  • Imbalances or overgrowth of normal gut microbes.

When the gut immune system becomes overwhelmed the single cell lining of the small intestine can become damaged leading to a leak in the barrier. This can allow semi digested food particles and bacterial toxins to cross the barrier leading to food allergies and inflammation. More and more evidence is linking inflammation and altered immune response in the gastrointestinal tract with chronic illnesses ranging from rheumatoid arthritis to heart disease to certain forms of cancer.

Luckily there are simple steps that you can take to help support a health small intestine and the gut immune system.

  • Eat a diet that contains optimal levels of nutrients to support the gut immune system including: vitamin A (green leafy vegetables, yellow and orange vegetables, fruits, egg yolks, and oily fish such as sardine), vitamin C (citrus fruit, blackberries, raspberries, kiwis, cruciferous vegetables, and sweet potatoes), zinc (pumpkin seeds, whole grains, and legumes), and fiber (fruits, vegetables, legumes, whole grains, nuts, and seeds).
  • Consume foods high in glutamine. Glutamine is an amino acid that is used by the cells of the small intestine for fuel. Good food sources include: cabbage, spinach, fish, chicken, eggs, legumes, nuts, seeds, and parsley.
  • Eat healthy fats. Healthy fats can help to support proper immune function and reduce inflammation. Good food sources of fats include wild cold water fish (sardines, salmon, and anchovies), avocados, olive oil, walnuts, almonds, coconut oil, pumpkin seeds, flax oil, and flax seeds.
  • Maintain optimal levels of stomach acid. As mentioned in the last blog, stomach acid helps to destroy harmful bacteria, parasites, and viruses. By getting rid of them before they get to the small intestine it decreases the load that the gut immune system has to deal with.
  • Avoid food allergens and food sensitivities. Eating foods that you are allergic to or that you are sensitive to can over activate your gut immune system leading to further damage and inflammation. An allergy elimination diet can be helpful in identifying foods you are reacting to.
  • Reduce stress. Stress increases your inflammatory response and has a negative impact on the gut-immune system. Exercise, meditation, yoga, journaling, massage, and breathing exercises can all help reduce the stress response.

Anything that was not absorbed in the small intestine will continue its way down the gastrointestinal tract where it will serve as food for our gut bacteria and ultimately be excreted. In the next blog we will finish our journey through the gastrointestinal tract as we make our way through the large intestine and meet the trillions of bacteria that call it home.

The Road to Health is Paved with Good Intestines #4: The Stomach

iStock_000012048107Small-300x300Last month our journey through the gastrointestinal tract took us from the mouth down the tube called the esophagus.  As the journey continues in this the fourth blog in this series, we have come out of the esophagus and found our way into the stomach.

When most people think about digestion, the stomach is probably the first thing that comes to mind.  The stomach is a muscular, elastic pear shaped bag that can comfortably hold about a quart of food.  It is in the stomach where the real physical dis-assembly of the food you ate takes place.

The stomach has three tools that it uses to accomplish this.  First it produces hydrochloric acid that breaks down the proteins in our food and kills bacteria that may have been growing on our food to prevent infection.  Second it produces digestive enzymes that further help to rip apart proteins, fats, and carbohydrates.  Third the muscular mechanical action of the stomach physically macerates the food into small particles allowing the acid and the enzymes to work even more effectively.

From the time that you eat a food, it typically takes 2 to 4 hours for the stomach to work on breaking it down before letting it continue on to the small intestine.  By the time it is released into the small intestine it should bear no resemblance to the meal that you ate.

Unfortunately, there are many things that can impair this function from occurring optimally such as:

  • Eating while you are under stress or eating without paying attention to what you are eating.
  • Eating too fast and not chewing your food well.
  • Taking antacid and acid blocking medications
  • Eating too much
  • Low stomach acid production
  • Infection with the bacteria H. pylori

Some of the consequences of impaired stomach digestive function include:

  • Stomach pain
  • Reflux or heartburn
  • Gas and bloating
  • Nausea
  • Constipation or diarrhea
  • Nutrient deficiencies or insufficiencies
  • Increased risk of developing food sensitivities
  • Increase risk of developing chronic bacterial infections of the small intestine.

The stomach actually works better when it is not completely full.  Have you ever tried to use your blender when it is too full? You end up with a big mess all over the kitchen and your smoothie doesn’t get blended very well.  If the stomach is too full it can’t break things down very well.  In addition pressure builds up and the stomach contents can find their way back up into the esophagus.  When this happens it can cause the burning that we associate with heartburn.

In order to optimize he ability of your stomach to adequately break down you food and prepare it for its journey through the small intestine, I recommend the following:

  • Try to eat in a calm, relaxed, mindful state.  (See the first blog in this series for more details.)
  • Chew your food thoroughly before swallowing.  (See the second blog in this series for more details).
  • Do not over eat.  Eat only until you are about 80% full to allow your stomach room to do its work.
  • Eat slowly to allow the stomach time produce stomach acid and enzymes.
  • Avoid long term use of antacids or stomach blocking medications.  If you have to take these daily, it is time to seek professional guidance to determine and fix the underlying issues.
  • To help further stimulate the digestive function consider taking digestive bitters (see last month’s blog) or drink the juice of half a lemon in 3 to 4oz of room temperature water before you eat.

If symptoms persist, you may need to supplement with digestive enzymes or hydrochloric acid.  Working with a practitioner who is knowledgeable about optimizing digestive function can be helpful in determining if these therapies may be helpful and how best to use them.

You may be wondering why the hydrochloric acid in your stomach doesn’t it just burn a hole right through it.  Fortunately for us, the lining of our stomach is protected by a layer of mucous.  However if that mucous layer breaks down it will allow the acid to burn a hole in the lining.  This is what happens when someone develops an ulcer.

While it used to be though that most ulcers were caused by stress, it has since been found that there is a bacteria called Helicobacter pylori that is to blame.  While most bacteria are killed off in the acid environment, H. pylori can thrive in it leading to irritation, inflammation, and ulceration of the stomach lining.  When this happens, it not only hurts, but it also impairs digestion by decreasing stomach acid production and it impairs absorption of certain vitamins and minerals such as zinc and vitamin B21.

While treatment of stomach ulcers can often require the use of antibiotics, the licorice compound that I mentioned in last month’s blog (DGL) can often be helpful in restoring the mucous lining to the stomach and getting rid of the bacteria H. pylori. 1 to 2 tablets chewed before each meal can often helped to relieve symptoms and allow healing to take place.

Severe cases of ulceration can lead to blood loss and be a serious health concern.  If symptoms persist or get worse, seek care from your health care practitioner.

Now that our food has been effectively broken down by the stomach, in our next blog we will look at how we absorb those nutrients in the small intestine and what can cause that ability to be impaired.

The Road to Health is Paved with Good Intestines #3: The Esophagus

iStock_000012048107Small-300x300When last we left our journey through the digestive tract, we had prepared ourselves to eat in a relaxed state; we took a bite of food, and chewed it well to get the digestive process started.  Now its time to swallow.

We go through the act of swallowing countless times a day and think of it as a mindless act.  In actuality, swallowing is the last step in the digestive process that we have conscious control over.  Once we have swallowed that bite of food, it has begun its 30 foot journey that can last any where from 12 hours to days depending upon how well things are working.

The first part of that journey takes it through the esophagus, a muscular tube that is about 9 inches in length in adults.  The job of the esophagus is mainly to transport the food that has begun the digestive process to the stomach so that is can be broken down further.  Motion in the esophagus should be in only one direction- down to the stomach.  When digestion is working well and if you have chewed your food appropriately, you shouldn’t really notice your esophagus.

Unfortunately, many things can cause this process to go awry, and allow the acid and digestive enzymes of the stomach (sometimes along with some of the digested food) to come back up into the esophagus.  This is what happens when you experience reflux or heartburn.  While the stomach has a nice protective coating so that the acid does not irritate it, the esophagus does not have this.  So when acid comes up into the esophagus, it burns and causes discomfort.

If this happens occasionally after over eating a large meal, or laying down too soon after you eat, it is not a big deal.  However, when this occurs on a regular basis, the acid can cause damage to the esophagus and even increase the risk of ulceration and cancer in the esophagus.  This chronic reflux is called GERD or Gastro Esophageal Reflux Disease.

bitter_little_pill-taker3-300x279While this condition was hardly recognized thirty years ago, it has grown to almost epidemic proportions with 30 to 60 million people in the US suffering with it each year.  It has sparked a huge industry of medications designed to neutralize or block the production of stomach acid.  Sales of these acid blocking medications accounted for more than $13 billion dollars last year. The direct marketing commercials have become routine on television and in magazines with competition between little purple pills and berry flavored pills.  It has become so common for people to be taking one of these medications that you would think stomach acid was an evil thing.

While we shall see in the next blog that stomach acid is actually important and there can be negative consequences to not having enough of it, too much stomach acid is rarely the underlying cause of heartburn and GERD.

More commonly the problem is associated with weakness of the gate or lower esophageal sphincter (LES) at the bottom of the esophagus that is supposed to keep the acid out of the esophagus.  This gate can become weakened by overeating, being overweight, food sensitivities, smoking, coffee, not chewing your food well before swallowing, and not being in a relaxed or parasympathetic state when you are eating.

Reducing reflux can often be as easy as:

  • Following the advice in the first two blogs of this series by being in a relaxed state when you eat and taking the time to chew your food well before swallowing
  • Avoiding foods that can weaken the lower esophageal sphincter (LES) such as tomatoes, onions, citrus, citrus, peppermint, caffeine, and alcohol
  • Discovering and eliminating hidden food allergies or sensitivities to foods such as wheat, dairy products, corn, and soy.
  • Quitting smoking
  • Working on stress reduction
  • Working on achieving an optimal body weight.
  • Not laying down too soon after eating.

While you are working on making these changes, there are a couple of natural supplements that can help reduce the severity of heartburn or GERD.

LicoriceRootThe first is a form of licorice called deglycerrhizinated licorice or DGL.  Licorice has been used for centuries for its soothing effect on the entire gastrointestinal tract.  It helps to increase the mucous production of the lining of the esophagus, protecting it from the irritation of stomach acid.  While there is concern with regular intake of whole licorice as it can raise blood pressure in some people, DGL has had the blood pressure raising component taken out.  This makes it safe to take on a regular basis while you are working on the underlying causes of your heartburn or reflux.  Because we want the effects of the licorice to help the esophagus it is important to use DGL products that are powders or chewable wafers.  Chewing 1 to2 of these tablets before meals or when you first start to feel reflux coming on can help to quench the fire without suppressing your digestive function.

Bitter herbs have been consumed before and after meals for centuries to help stimulate digestive function.  While bitters have become most commonly used now as a component of cocktails, digestive bitters can be effective at reducing the occurrence of heartburn.  Taking the bitters in a small amount of room temperature water 10 minutes before meals can help to stimulate your digestive function and put an end to the burning discomfort.

The amount of bitters that you should take is going to vary from product to product, so look at the instructions on the package to determine how much to take.

While these natural remedies can be helpful, if you are experiencing frequent heartburn or reflux, it is important to figure out the underlying cause and correct it.  Working with a naturopathic doctor or Functional medicine practitioner can be helpful for determining and treating those underlying causes without impairing digestive function by inhibiting the production of stomach acid.

In the next blog we will move into the stomach, learn more about the important actions of stomach acid and curious bacteria called H. pylori.

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